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General NPI Number Information
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NPI Number | 1184778565
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Entity Type | Organization
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Legal Business Name | PEARL CITY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 803 KAMEHAMEHA HWY STE 309
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City | PEARL CITY
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State | HI
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Zip | 96782-2638
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Country | US
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Telephone | 808-456-5553
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Fax | 808-455-6520
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Provider Business Mailing Address
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Address Line | 803 KAMEHAMEHA HWY STE 309
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City | PEARL CITY
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State | HI
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Zip | 96782-2638
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Country | US
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Telephone | 808-456-5553
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Fax | 808-455-6520
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Authorized Official
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Title or Position | MEMBER
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Name | DR. CHRISTOPHER MITCHELL NOWICKI
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Credential | D.C., D.A.B.C.O.
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Telephone | 808-456-5553
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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 | W20589308-01
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License Number State | HI
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