Provider Demographics
NPI:1770975856
Name:REX NIIMOTO DC INC.
Entity type:Organization
Organization Name:REX NIIMOTO DC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:K
Authorized Official - Last Name:NIIMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-488-7751
Mailing Address - Street 1:98-211 PALI MOMI ST
Mailing Address - Street 2:SUITE 506
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4301
Mailing Address - Country:US
Mailing Address - Phone:808-488-7751
Mailing Address - Fax:808-488-1963
Practice Address - Street 1:98-211 PALI MOMI ST
Practice Address - Street 2:SUITE 506
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4301
Practice Address - Country:US
Practice Address - Phone:808-488-7751
Practice Address - Fax:808-488-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000QCBSLMedicare PIN