Provider Demographics
NPI:1467088146
Name:VIESELMEYER, SKYLAR STERLING (DC)
Entity Type:Individual
Prefix:
First Name:SKYLAR
Middle Name:STERLING
Last Name:VIESELMEYER
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 1:91-1123 KEAUNUI DR STE 228
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6370
Mailing Address - Country:US
Mailing Address - Phone:253-375-3030
Mailing Address - Fax:
Practice Address - Street 1:91-1123 KEAUNUI DR # 228
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6364
Practice Address - Country:US
Practice Address - Phone:253-375-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-1458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor