Provider Demographics
NPI:1942074349
Name:NAGAO, TYLER IKAIKA CHIYOTO (DC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:IKAIKA CHIYOTO
Last Name:NAGAO
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 1:3092 AKAHI ST
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1103
Mailing Address - Country:US
Mailing Address - Phone:808-652-3398
Mailing Address - Fax:
Practice Address - Street 1:3092 AKAHI ST
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1103
Practice Address - Country:US
Practice Address - Phone:808-652-3398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35154111N00000X
HI1562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor