Provider Demographics
NPI:1871355677
Name:KONA CHIROPRACTIC LLC
Entity type:Organization
Organization Name:KONA CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KONA
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-882-3555
Mailing Address - Street 1:604 E MUSSER ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-4200
Mailing Address - Country:US
Mailing Address - Phone:775-882-3555
Mailing Address - Fax:888-505-5903
Practice Address - Street 1:604 E MUSSER ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-4200
Practice Address - Country:US
Practice Address - Phone:775-882-3555
Practice Address - Fax:888-505-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty