=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588684898
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROY JIMMY LOZANO DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2006
-----------------------------------------------------
Last Update Date | 10/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15-2891 GOVERNMENT MAIN RD 2ND FLOOR
-----------------------------------------------------
City | PAHOA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-965-6623
-----------------------------------------------------
Fax | 808-965-6633
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1048
-----------------------------------------------------
City | PAHOA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-965-6623
-----------------------------------------------------
Fax | 808-965-6633
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 510
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------