Healthcare Provider Details

I. General information

NPI: 1821272527
Provider Name (Legal Business Name): ANTHONY B HAWKINS DC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7773 UNIVERSITY AVE
LA MESA CA
91941-4950
US

IV. Provider business mailing address

7773 UNIVERSITY AVE
LA MESA CA
91941-4950
US

V. Phone/Fax

Practice location:
  • Phone: 619-465-3000
  • Fax: 619-465-3003
Mailing address:
  • Phone: 619-465-3000
  • Fax: 619-465-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC11743
License Number StateCA

VIII. Authorized Official

Name: ANTHONY B HAWKINS
Title or Position: PRESIDENT
Credential: DC
Phone: 619-465-3000