Provider Demographics
NPI:1508857632
Name:PUKALANI CHIROPRACTIC INC
Entity Type:Organization
Organization Name:PUKALANI CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MAIN
Authorized Official - Last Name:JANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-572-5599
Mailing Address - Street 1:7 AEWA PL
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8882
Mailing Address - Country:US
Mailing Address - Phone:808-572-5599
Mailing Address - Fax:808-572-0394
Practice Address - Street 1:7 AEWA PL
Practice Address - Street 2:SUITE 12
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8882
Practice Address - Country:US
Practice Address - Phone:808-572-5599
Practice Address - Fax:808-572-0394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI0000362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty