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General NPI Number Information
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NPI Number | 1780737759
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Entity Type | Organization
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Legal Business Name | IASIS SPINAL TREATMENT CENTER, LLC
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Dates
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Enumeration Date | 01/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4747 KILAUEA AVE #201
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City | HONOLULU
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State | HI
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Zip | 96816-5308
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Country | US
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Telephone | 808-542-4029
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Fax | 808-739-2828
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Provider Business Mailing Address
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Address Line | 45-502 APIKI ST
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City | KANEOHE
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State | HI
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Zip | 96744-1918
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Country | US
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Telephone | 808-542-4029
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Fax | 808-739-2828
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Authorized Official
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Title or Position | MEMBER
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Name | MR. ERIC SEIYO KAMIMURA
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Credential | P.T.
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Telephone | 808-542-4029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1497
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License Number State | HI
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