Provider Demographics
NPI:1679294250
Name:TIDE OSTEOPATHY, LLC
Entity type:Organization
Organization Name:TIDE OSTEOPATHY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LOVE
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-721-2629
Mailing Address - Street 1:111 HEKILI ST STE A504
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2800
Mailing Address - Country:US
Mailing Address - Phone:808-721-2629
Mailing Address - Fax:
Practice Address - Street 1:320 ULUNIU ST STE 2
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2529
Practice Address - Country:US
Practice Address - Phone:808-721-5410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center