Healthcare Provider Details

I. General information

NPI: 1942215744
Provider Name (Legal Business Name): PRINCEVILLE CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5-4280 KUHIO HWY SUITE B206
PRINCEVILLE HI
96722-5438
US

IV. Provider business mailing address

PO BOX 223489
PRINCEVILLE HI
96722-3489
US

V. Phone/Fax

Practice location:
  • Phone: 808-826-7000
  • Fax: 808-826-7600
Mailing address:
  • Phone: 808-826-7000
  • Fax: 808-826-7600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number936
License Number StateHI

VIII. Authorized Official

Name: SALLY ANN BOWEN
Title or Position: OWNER
Credential: D.C.
Phone: 808-826-7000