Provider Demographics
NPI:1184778565
Name:PEARL CITY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:PEARL CITY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:NOWICKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DABCO
Authorized Official - Phone:808-456-5553
Mailing Address - Street 1:803 KAMEHAMEHA HWY STE 309
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2638
Mailing Address - Country:US
Mailing Address - Phone:808-456-5553
Mailing Address - Fax:808-455-6520
Practice Address - Street 1:803 KAMEHAMEHA HWY STE 309
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2638
Practice Address - Country:US
Practice Address - Phone:808-456-5553
Practice Address - Fax:808-455-6520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW20589308-01111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty