Provider Demographics
NPI:1659434090
Name:TAKATA, ANNE MAILE (DC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MAILE
Last Name:TAKATA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-029 HEKAHA ST STE 8
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4917
Mailing Address - Country:US
Mailing Address - Phone:808-487-8885
Mailing Address - Fax:
Practice Address - Street 1:98-029 HEKAHA ST STE 8
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4917
Practice Address - Country:US
Practice Address - Phone:808-487-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27544111N00000X
HI888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor