Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC129 | HI |
NPI | 1356492052 |
---|---|
Provider Name | Dr. Stephen Andrew Tarek |
First Address | Honolulu, HI 96822-1858 |
Second Address | Honolulu, HI 96822-1858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U11376 | (02) | HI |