Provider Demographics
NPI:1295248813
Name:KEOLAHOU LLC
Entity type:Organization
Organization Name:KEOLAHOU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-283-5196
Mailing Address - Street 1:360 HOOHANA ST STE A104
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2975
Mailing Address - Country:US
Mailing Address - Phone:808-877-1534
Mailing Address - Fax:
Practice Address - Street 1:360 HOOHANA ST STE A104
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2975
Practice Address - Country:US
Practice Address - Phone:808-877-1534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty