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General NPI Number Information
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NPI Number | 1144266453
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Entity Type | Individual
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Provider Name | TRACY C MATSUMOTO D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 703 KILANI AVE
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City | WAHIAWA
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State | HI
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Zip | 96786-2001
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Country | US
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Telephone | 808-621-6299
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Fax | 808-621-0006
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Provider Business Mailing Address
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Address Line | 703 KILANI AVE
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City | WAHIAWA
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State | HI
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Zip | 96786-2001
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Country | US
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Telephone | 808-621-6299
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Fax | 808-621-0006
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC386
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License Number State | HI
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