Healthcare Provider Details

I. General information

NPI: 1265102693
Provider Name (Legal Business Name): MALAMA CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 08/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5-4280 KUHIO HWY # B-206
PRINCEVILLE HI
96722-5451
US

IV. Provider business mailing address

4163 WAIPUA ST
KILAUEA HI
96754-5334
US

V. Phone/Fax

Practice location:
  • Phone: 808-634-2159
  • Fax: 808-826-7600
Mailing address:
  • Phone: 808-634-2159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. KALANI STANLEY WALTHER
Title or Position: OWNER
Credential: DC
Phone: 808-634-2159