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General NPI Number Information
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NPI Number | 1124288972
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Entity Type | Organization
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Legal Business Name | ICHISHITA LLC DBA
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Dates
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Enumeration Date | 06/16/2008
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 75-5591 PALANI ROAD SUITE 207
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City | KAILUA-KONA
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State | HI
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Zip | 96740-3632
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Country | US
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Telephone | 808-327-9845
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Fax | 808-329-9038
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Provider Business Mailing Address
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Address Line | 75-5591 PALANI ROAD SUITE 207
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City | KAILUA-KONA
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State | HI
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Zip | 96740-3632
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Country | US
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Telephone | 808-327-9845
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Fax | 808-329-9038
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. TOD M ICHISHITA
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Credential | DC
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Telephone | 808-327-9845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC842
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License Number State | HI
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