Provider Demographics
NPI:1588675508
Name:STAUB, WILLIAM XAVIER (LAC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:XAVIER
Last Name:STAUB
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:BILL
Other - Middle Name:X
Other - Last Name:STAUB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:84-256 MAKAHA VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-2129
Mailing Address - Country:US
Mailing Address - Phone:808-695-9520
Mailing Address - Fax:
Practice Address - Street 1:84-256 MAKAHA VALLEY RD
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2129
Practice Address - Country:US
Practice Address - Phone:808-695-9520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU-748171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist