Provider Demographics
NPI:1659464170
Name:TANAKA, COLLEEN T (DC)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:T
Last Name:TANAKA
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 1:98-027 HEKAHA ST STE 17
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4919
Mailing Address - Country:US
Mailing Address - Phone:808-487-2273
Mailing Address - Fax:808-356-0337
Practice Address - Street 1:98-027 HEKAHA ST STE 17
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4919
Practice Address - Country:US
Practice Address - Phone:808-487-2273
Practice Address - Fax:808-356-0337
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55630OtherMEDICARE GROUP #
HI0000212050OtherHMSA PROVIDER #
HI0000212050OtherHMSA PROVIDER #
HI55630OtherMEDICARE GROUP #