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General NPI Number Information
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NPI Number | 1497048110
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Entity Type | Organization
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Legal Business Name | DOHERTY CHIROPRACTIC PC
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Dates
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Enumeration Date | 05/27/2011
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Last Update Date | 11/02/2017
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Provider Practice Location Address
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Address Line | 65-1231 OPELO RD STE 3
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City | KAMUELA
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State | HI
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Zip | 96743-8376
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Country | US
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Telephone | 808-885-9300
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Fax | 808-885-9060
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Provider Business Mailing Address
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Address Line | PO BOX 6318
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City | KAMUELA
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State | HI
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Zip | 96743-6318
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Country | US
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Telephone | 808-885-9300
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Fax | 808-885-9060
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD DOHERTY
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Credential |
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Telephone | 808-885-9300
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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 | 1038
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License Number State | HI
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