Provider Demographics
NPI:1700035953
Name:CHI LIFESTYLE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:CHI LIFESTYLE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHRISTENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-779-3985
Mailing Address - Street 1:934 MAUNAWILI CIR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4619
Mailing Address - Country:US
Mailing Address - Phone:808-261-7801
Mailing Address - Fax:808-261-7725
Practice Address - Street 1:934 MAUNAWILI CIR
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4619
Practice Address - Country:US
Practice Address - Phone:808-261-7801
Practice Address - Fax:808-261-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-12322261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center