Provider Demographics
NPI:1538194170
Name:ABBADESSA, BERNARD ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:ANTHONY
Last Name:ABBADESSA
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 1:46-001 KAMEHAMEHA HWY
Mailing Address - Street 2:STE 419B
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3749
Mailing Address - Country:US
Mailing Address - Phone:808-234-5535
Mailing Address - Fax:808-234-5503
Practice Address - Street 1:46-001 KAMEHAMEHA HWY
Practice Address - Street 2:STE 419B
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3749
Practice Address - Country:US
Practice Address - Phone:808-234-5535
Practice Address - Fax:808-234-5503
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54286Medicare ID - Type Unspecified