=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720250780
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRAVIS TAIRA D.C., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2008
-----------------------------------------------------
Last Update Date | 03/03/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2525 S KING ST SUITE 303
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96826-3154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-948-8722
-----------------------------------------------------
Fax | 808-948-8724
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2525 S KING ST SUITE 303
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96826-3154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-948-8722
-----------------------------------------------------
Fax | 808-948-8724
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TRAVIS NAOKI TAIRA
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 808-948-8722
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 967
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------