Provider Demographics
NPI:1669559217
Name:MAR, STEPHEN J (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:MAR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 11TH AVE
Mailing Address - Street 2:STE. 301
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2433
Mailing Address - Country:US
Mailing Address - Phone:808-738-5512
Mailing Address - Fax:808-738-5512
Practice Address - Street 1:1123 11TH AVE
Practice Address - Street 2:STE. 301
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-2433
Practice Address - Country:US
Practice Address - Phone:808-738-5512
Practice Address - Fax:808-738-5512
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI20544-3OtherHMSA
HI52943Medicare ID - Type Unspecified
HI20544-3OtherHMSA