Provider Demographics
NPI:1356492052
Name:TAREK, STEPHEN ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ANDREW
Last Name:TAREK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 EAST MANOA ROAD 1-205
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1858
Mailing Address - Country:US
Mailing Address - Phone:808-988-6133
Mailing Address - Fax:808-988-5637
Practice Address - Street 1:2851 E MANOA RD STE 1-205
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1858
Practice Address - Country:US
Practice Address - Phone:808-988-6133
Practice Address - Fax:808-988-5637
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC129111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI101485Medicare PIN
HIU11376Medicare UPIN