Provider Demographics
NPI:1295909489
Name:LAHAINA HEALTH CENTER, INCORPORATED
Entity type:Organization
Organization Name:LAHAINA HEALTH CENTER, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:RA
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-667-6268
Mailing Address - Street 1:180 DICKENSON ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1215
Mailing Address - Country:US
Mailing Address - Phone:808-667-6268
Mailing Address - Fax:808-667-6269
Practice Address - Street 1:180 DICKENSON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1215
Practice Address - Country:US
Practice Address - Phone:808-667-6268
Practice Address - Fax:808-667-6269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI#1508937715OtherPROVIDER NPI NUMBER
HI#1508937715OtherPROVIDER NPI NUMBER
HI0000-QCCGKMedicare PIN