=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104638329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISLAND HOLISTIC HEALING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2025
-----------------------------------------------------
Last Update Date | 01/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 68-1820 WAIKOLOA RD STE 501
-----------------------------------------------------
City | WAIKOLOA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96738-5597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-209-8002
-----------------------------------------------------
Fax | 440-212-7006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 68-1749 HOOHIKI PL
-----------------------------------------------------
City | WAIKOLOA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96738-5105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-209-8002
-----------------------------------------------------
Fax | 440-212-7006
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NICHOLAS M TANCHEFF
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 808-209-8002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------