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General NPI Number Information
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NPI Number | 1154721355
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Entity Type | Organization
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Legal Business Name | SOL CHIROPRACTIC INC.
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Dates
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Enumeration Date | 08/26/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 30 E. LIPOA ST #4-102
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City | KIHEI
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State | HI
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Zip | 96753-8122
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Country | US
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Telephone | 715-222-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 30 E. LIPOA ST #4-102
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City | KIHEI
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State | HI
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Zip | 96753-8122
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Country | US
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Telephone | 715-222-2800
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHERINE M GRAVESEN
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Credential | D.C.
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Telephone | 715-222-2800
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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 | 1238
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License Number State | HI
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