Provider Demographics
NPI:1275238974
Name:SIMONSON, KAYLA M (DC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:M
Last Name:SIMONSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 KIOPAA PL STE 201
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8291
Mailing Address - Country:US
Mailing Address - Phone:808-575-5483
Mailing Address - Fax:
Practice Address - Street 1:12 KIOPAA PL STE 201
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8291
Practice Address - Country:US
Practice Address - Phone:808-575-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-1557-0111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor