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General NPI Number Information
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NPI Number | 1679294250
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Entity Type | Organization
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Legal Business Name | TIDE OSTEOPATHY, LLC
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 320 ULUNIU ST STE 2
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City | KAILUA
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State | HI
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Zip | 96734-2529
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Country | US
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Telephone | 808-721-5410
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Fax |
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Provider Business Mailing Address
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Address Line | 111 HEKILI ST STE A504
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City | KAILUA
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State | HI
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Zip | 96734-2800
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Country | US
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Telephone | 808-721-2629
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. LOVE VOLKOVA
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Credential | DO
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Telephone | 808-721-2629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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