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General NPI Number Information
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NPI Number | 1508857632
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Entity Type | Organization
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Legal Business Name | PUKALANI CHIROPRACTIC INC
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7 AEWA PL SUITE 12
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City | MAKAWAO
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State | HI
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Zip | 96768-8882
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Country | US
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Telephone | 808-572-5599
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Fax | 808-572-0394
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Provider Business Mailing Address
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Address Line | 7 AEWA PL SUITE 12
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City | MAKAWAO
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State | HI
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Zip | 96768-8882
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Country | US
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Telephone | 808-572-5599
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Fax | 808-572-0394
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW MAIN JANSSEN
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Credential | D.C.
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Telephone | 808-572-5599
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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 | 0000362
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License Number State | HI
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