Provider Demographics
NPI:1972762359
Name:HOWARD RODGERS DC PC
Entity Type:Organization
Organization Name:HOWARD RODGERS DC PC
Other - Org Name:WAIMEA CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-885-7719
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-0729
Mailing Address - Country:US
Mailing Address - Phone:808-885-7719
Mailing Address - Fax:808-885-4450
Practice Address - Street 1:65-1298B KAWAIHAE ROAD
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-0729
Practice Address - Country:US
Practice Address - Phone:808-885-7719
Practice Address - Fax:808-885-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC77111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIDC77OtherSTATE OF HAWAII LICENSE
HI55440Medicare PIN
HIDC77OtherSTATE OF HAWAII LICENSE