Provider Demographics
NPI:1053081273
Name:KAILUA ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:KAILUA ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-262-4550
Mailing Address - Street 1:320 ULUNIU ST STE 2
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2529
Mailing Address - Country:US
Mailing Address - Phone:808-262-4550
Mailing Address - Fax:855-594-5059
Practice Address - Street 1:320 ULUNIU ST STE 2
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2529
Practice Address - Country:US
Practice Address - Phone:808-262-4550
Practice Address - Fax:855-594-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-18
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000302455OtherBCBS