Provider Demographics
NPI:1265102693
Name:MALAMA CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:MALAMA CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KALANI
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:WALTHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-634-2159
Mailing Address - Street 1:4163 WAIPUA ST
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-5334
Mailing Address - Country:US
Mailing Address - Phone:808-634-2159
Mailing Address - Fax:
Practice Address - Street 1:5-4280 KUHIO HWY # B-206
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:808-634-2159
Practice Address - Fax:808-826-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1639278252OtherNPPES