Provider Demographics
NPI:1972007680
Name:ADVANCED BODYWORKS PHYSICAL MEDICINE
Entity Type:Organization
Organization Name:ADVANCED BODYWORKS PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-439-6292
Mailing Address - Street 1:65-1291 KAWAIHAE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8358
Mailing Address - Country:US
Mailing Address - Phone:808-439-6292
Mailing Address - Fax:
Practice Address - Street 1:65-1291 KAWAIHAE RD STE 203
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8358
Practice Address - Country:US
Practice Address - Phone:808-439-6292
Practice Address - Fax:808-930-9840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC1373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000385039OtherHMSA