Provider Demographics
NPI:1659006286
Name:NORTH SHORE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:NORTH SHORE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-291-2542
Mailing Address - Street 1:66-590 KAMEHAMEHA HWY STE 1B
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-1484
Mailing Address - Country:US
Mailing Address - Phone:808-291-2542
Mailing Address - Fax:808-491-9000
Practice Address - Street 1:66-590 KAMEHAMEHA HWY STE 1B
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1484
Practice Address - Country:US
Practice Address - Phone:808-291-2542
Practice Address - Fax:808-491-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty