Provider Demographics
NPI:1356954820
Name:KEATH, ZELLDA (DAOM, LAC)
Entity type:Individual
Prefix:
First Name:ZELLDA
Middle Name:
Last Name:KEATH
Suffix:
Gender:F
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:ZELLDA
Other - Middle Name:
Other - Last Name:KEATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DAOM, LAC
Mailing Address - Street 1:PO BOX 1201
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-1201
Mailing Address - Country:US
Mailing Address - Phone:401-487-2195
Mailing Address - Fax:
Practice Address - Street 1:KOHANAIKI CLUB SERVICES
Practice Address - Street 2:73-2055 ALA KOHANAIKI
Practice Address - City:KAILUA-KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-896-7341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI808171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty