Provider Demographics
NPI:1053426429
Name:VICARS, DANIEL B (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:VICARS
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 1:220 LALO ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3502
Mailing Address - Country:US
Mailing Address - Phone:808-873-9392
Mailing Address - Fax:808-873-9390
Practice Address - Street 1:220 LALO ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3502
Practice Address - Country:US
Practice Address - Phone:808-873-9392
Practice Address - Fax:808-873-9390
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC 840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH101468Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER