Provider Demographics
NPI:1790018596
Name:GREEN, DOUGLAS KOAKANE (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:KOAKANE
Last Name:GREEN
Suffix:
Gender:M
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:PO BOX 5154
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-5154
Mailing Address - Country:US
Mailing Address - Phone:808-938-9870
Mailing Address - Fax:808-328-9926
Practice Address - Street 1:75-5852 ALII DR
Practice Address - Street 2:SUITE 166
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1310
Practice Address - Country:US
Practice Address - Phone:808-334-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor