Provider Demographics
NPI:1841522471
Name:ALOHA PAIN SPORTS & SPINE MEDICINE LLC
Entity type:Organization
Organization Name:ALOHA PAIN SPORTS & SPINE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KERREY
Authorized Official - Middle Name:L BARTON
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-261-7246
Mailing Address - Street 1:407 ULUNIU ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2519
Mailing Address - Country:US
Mailing Address - Phone:808-261-7246
Mailing Address - Fax:808-261-7248
Practice Address - Street 1:407 ULUNIU ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2519
Practice Address - Country:US
Practice Address - Phone:808-261-7246
Practice Address - Fax:808-261-7248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD143222081S0010X
HIDOS11532081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty