Provider Demographics
NPI:1134609571
Name:PRINCEVILLE CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:PRINCEVILLE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMADA
Authorized Official - Middle Name:LUZ
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-826-7000
Mailing Address - Street 1:PO BOX 223489
Mailing Address - Street 2:
Mailing Address - City:PRINCEVILLE
Mailing Address - State:HI
Mailing Address - Zip Code:96722-3489
Mailing Address - Country:US
Mailing Address - Phone:808-826-7000
Mailing Address - Fax:808-826-7600
Practice Address - Street 1:5-4280 KUHIO HWY STE B206
Practice Address - Street 2:
Practice Address - City:PRINCEVILLE
Practice Address - State:HI
Practice Address - Zip Code:96722-5451
Practice Address - Country:US
Practice Address - Phone:808-826-7000
Practice Address - Fax:808-826-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-1398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty