Healthcare Provider Details

I. General information

NPI: 1356425532
Provider Name (Legal Business Name): GEORGE ERMANO RAQUEL D. C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-216 FARRINGTON HWY STE B1-3
WAIPAHU HI
96797-1900
US

IV. Provider business mailing address

94-216 FARRINGTON HWY STE B1-3
WAIPAHU HI
96797-1900
US

V. Phone/Fax

Practice location:
  • Phone: 808-676-1717
  • Fax: 808-678-1122
Mailing address:
  • Phone: 808-676-1717
  • Fax: 808-678-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number815
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: