Provider Demographics
NPI:1689496515
Name:BALDOMERO, RANDY KIWINI (DC)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:KIWINI
Last Name:BALDOMERO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:99-080 KAUHALE ST STE D9
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4114
Mailing Address - Country:US
Mailing Address - Phone:808-637-2608
Mailing Address - Fax:808-748-0161
Practice Address - Street 1:99-080 KAUHALE ST STE D9
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4114
Practice Address - Country:US
Practice Address - Phone:808-637-2608
Practice Address - Fax:808-748-0161
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-1616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor