Provider Demographics
NPI:1801964390
Name:VALLEY ISLE CHIROPRACTIC INC
Entity type:Organization
Organization Name:VALLEY ISLE CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNI
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-877-5587
Mailing Address - Street 1:444 HANA HWY
Mailing Address - Street 2:#213
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2315
Mailing Address - Country:US
Mailing Address - Phone:808-877-5587
Mailing Address - Fax:808-871-8024
Practice Address - Street 1:444 HANA HWY
Practice Address - Street 2:#213
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2315
Practice Address - Country:US
Practice Address - Phone:808-877-5587
Practice Address - Fax:808-871-8024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U99249Medicare UPIN
HI56422Medicare ID - Type Unspecified