=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962395780
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEARL CITY HEALTH AND WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2025
-----------------------------------------------------
Last Update Date | 06/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 945 KAMEHAMEHA HWY STE 8
-----------------------------------------------------
City | PEARL CITY
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96782-2521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-456-5553
-----------------------------------------------------
Fax | 808-455-6520
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11603
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96828-0603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-456-5553
-----------------------------------------------------
Fax | 808-455-6520
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO- OWNER
-----------------------------------------------------
Name | CHRISTOPHER NOWICKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-456-5553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------