Provider Demographics
NPI:1568528982
Name:TANAKA, ROBERT I (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:I
Last Name:TANAKA
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 1:1028 KINOOLE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3800
Mailing Address - Country:US
Mailing Address - Phone:808-934-9355
Mailing Address - Fax:808-934-9354
Practice Address - Street 1:1028 KINOOLE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3800
Practice Address - Country:US
Practice Address - Phone:808-934-9355
Practice Address - Fax:808-934-9354
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29008111N00000X
HIDC1183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18089Medicare ID - Type Unspecified
CAV02016Medicare UPIN