Provider Demographics
NPI:1255483954
Name:HOGAN AND BRODERSON CHIROPRACTIC
Entity Type:Organization
Organization Name:HOGAN AND BRODERSON CHIROPRACTIC
Other - Org Name:MALAMA CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-329-7797
Mailing Address - Street 1:74-5620 PALANI RD STE 102
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3640
Mailing Address - Country:US
Mailing Address - Phone:808-329-7797
Mailing Address - Fax:808-329-2748
Practice Address - Street 1:74-5620 PALANI RD STE 102
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3640
Practice Address - Country:US
Practice Address - Phone:808-329-7797
Practice Address - Fax:808-329-2748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH56326Medicare ID - Type UnspecifiedDR. HOGAN MEDICARE
HIH56324Medicare ID - Type UnspecifiedDR. BRODERSON MEDICARE
HIU99035Medicare UPIN
HIU99036Medicare UPIN