Provider Demographics
NPI:1508300351
Name:MCLAUGHLIN, BRAD
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRADLEY
Other - Middle Name:
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2136 KONOU PL
Mailing Address - Street 2:APT. #101
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8775
Mailing Address - Country:US
Mailing Address - Phone:949-547-8597
Mailing Address - Fax:
Practice Address - Street 1:95 LONO AVE
Practice Address - Street 2:SUITE #105
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1610
Practice Address - Country:US
Practice Address - Phone:808-873-0733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPTA 326111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic