Provider Demographics
NPI:1942723572
Name:DILLBERG, KERRY L (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:L
Last Name:DILLBERG
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 ALA KINOIKI
Mailing Address - Street 2:
Mailing Address - City:KOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96756-8565
Mailing Address - Country:US
Mailing Address - Phone:808-742-9326
Mailing Address - Fax:808-742-9458
Practice Address - Street 1:2711 ALA KINOIKI
Practice Address - Street 2:
Practice Address - City:KOLOA
Practice Address - State:HI
Practice Address - Zip Code:96756-8565
Practice Address - Country:US
Practice Address - Phone:808-742-9326
Practice Address - Fax:808-742-9458
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC615111NN1001X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition