Provider Demographics
NPI:1831924034
Name:LUESUKPRASERT, SUTTIPONG (DC)
Entity type:Individual
Prefix:
First Name:SUTTIPONG
Middle Name:
Last Name:LUESUKPRASERT
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 1:55 S KUKUI ST APT D614
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2344
Mailing Address - Country:US
Mailing Address - Phone:563-200-8117
Mailing Address - Fax:
Practice Address - Street 1:512 KEAWE ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3101
Practice Address - Country:US
Practice Address - Phone:808-286-4287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor