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General NPI Number Information
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NPI Number | 1730388216
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Entity Type | Organization
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Legal Business Name | KOOLAU FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 415 ULUNIU ST STE D
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City | KAILUA
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State | HI
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Zip | 96734-2503
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Country | US
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Telephone | 808-262-2099
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1768
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City | KAILUA
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State | HI
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Zip | 96734-8768
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Country | US
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Telephone | 808-262-2099
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Fax |
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Authorized Official
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Title or Position | MANAGING MANAGER
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Name | DR. DEBORAH S.I. GLENN
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Credential | D.C.
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Telephone | 808-262-2099
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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 | DC 907
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License Number State | HI
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