Provider Demographics
NPI:1023537297
Name:TANIZAKI, VIRGIL (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:VIRGIL
Middle Name:
Last Name:TANIZAKI
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2176 LAUWILIWILI ST UNIT 1 OFFICE 12
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707
Mailing Address - Country:US
Mailing Address - Phone:808-465-3000
Mailing Address - Fax:808-465-3574
Practice Address - Street 1:2176 LAUWILIWILI ST UNIT 1 OFFICE 12
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707
Practice Address - Country:US
Practice Address - Phone:808-465-3000
Practice Address - Fax:808-465-3574
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIND-323175F00000X
WAAC60806748171100000X
WANT60790676175F00000X
175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty