Provider Demographics
NPI:1588684898
Name:LOZANO, ROY JIMMY (DC)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:JIMMY
Last Name:LOZANO
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:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778
Mailing Address - Country:US
Mailing Address - Phone:808-965-6623
Mailing Address - Fax:808-965-6633
Practice Address - Street 1:15-2891 GOVERNMENT MAIN RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778
Practice Address - Country:US
Practice Address - Phone:808-965-6623
Practice Address - Fax:808-965-6633
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI545410Medicaid
1042629OtherASH
HI00A0078798OtherHMSA
HI00A0078798OtherHMSA