Provider Demographics
NPI:1932590536
Name:BULOSAN, ADDISON (DC)
Entity Type:Individual
Prefix:DR
First Name:ADDISON
Middle Name:
Last Name:BULOSAN
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 1:2959 UMI ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1806
Mailing Address - Country:US
Mailing Address - Phone:808-369-9733
Mailing Address - Fax:808-369-9733
Practice Address - Street 1:2959 UMI ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1806
Practice Address - Country:US
Practice Address - Phone:808-369-9733
Practice Address - Fax:808-369-9733
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC1275111NT0100X
CA32701111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NT0100XChiropractic ProvidersChiropractorThermography