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General NPI Number Information
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NPI Number | 1972007680
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Entity Type | Organization
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Legal Business Name | ADVANCED BODYWORKS PHYSICAL MEDICINE
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 65-1291 KAWAIHAE RD STE 203
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City | KAMUELA
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State | HI
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Zip | 96743-8358
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Country | US
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Telephone | 808-439-6292
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Fax | 808-930-9840
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Provider Business Mailing Address
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Address Line | 65-1291 KAWAIHAE RD STE 203
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City | KAMUELA
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State | HI
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Zip | 96743-8358
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Country | US
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Telephone | 808-439-6292
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOREEN I KING
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Credential | DC
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Telephone | 808-439-6292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC1373
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License Number State | HI
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