Healthcare Provider Details

I. General information

NPI: 1093844565
Provider Name (Legal Business Name): BRENT ANDREW HALEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 W EL CAMINO REAL SUITE 4
MOUNTAIN VIEW CA
94040-1631
US

IV. Provider business mailing address

5050 EL CAMINO REAL STE 112
LOS ALTOS CA
94022-1531
US

V. Phone/Fax

Practice location:
  • Phone: 650-967-1152
  • Fax: 650-967-5328
Mailing address:
  • Phone: 650-967-1152
  • Fax: 650-967-5328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number22694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: