Provider Demographics
NPI:1467000323
Name:HILO BACK AND NECK PAIN CENTER
Entity Type:Organization
Organization Name:HILO BACK AND NECK PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MAT9178
Authorized Official - Phone:808-741-1242
Mailing Address - Street 1:118 PONAHAWAI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3004
Mailing Address - Country:US
Mailing Address - Phone:808-464-5195
Mailing Address - Fax:
Practice Address - Street 1:118 PONAHAWAI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3004
Practice Address - Country:US
Practice Address - Phone:808-464-5195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain