MEDICARE: PEARL CITY CHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	W20589308-01	HI

General Provider Information

NPI Number	:	1184778565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARL CITY CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	803 KAMEHAMEHA HWY STE 309
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-2638
Country	:	US
Telephone Number	:	808-456-5553
Fax Number	:	808-455-6520

Provider Business Practice Location Address
First Line	:	803 KAMEHAMEHA HWY STE 309
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-2638
Country	:	US
Telephone Number	:	808-456-5553
Fax Number	:	808-455-6520

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. CHRISTOPHER MITCHELL NOWICKI
Credential	:	D.C., D.A.B.C.O.
Telephone Number	:	808-456-5553

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	08/22/2020

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