Provider Demographics
NPI:1801980339
Name:DE DEO, EDWARD FRANKLIN (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:FRANKLIN
Last Name:DE DEO
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:PO BOX 3885470 KOLOA RD 2D
Mailing Address - Street 2:
Mailing Address - City:KOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96756-0388
Mailing Address - Country:US
Mailing Address - Phone:808-742-2055
Mailing Address - Fax:
Practice Address - Street 1:5470 KOLOA RD 2D
Practice Address - Street 2:
Practice Address - City:KOLOA
Practice Address - State:HI
Practice Address - Zip Code:96756-0388
Practice Address - Country:US
Practice Address - Phone:808-742-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000QCCFPMedicare ID - Type UnspecifiedID NUMBER