Provider Demographics
NPI:1669017851
Name:DEANE, LILY (DC)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:DEANE
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 1:91-530 MAKALEA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5941
Mailing Address - Country:US
Mailing Address - Phone:408-515-1880
Mailing Address - Fax:
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:808-637-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-1437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor