Healthcare Provider Details

I. General information

NPI: 1669613626
Provider Name (Legal Business Name): HALEY - CARR SPINAL & SPORTS CARE CHIROPRACTIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 03/20/2009
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

2290 W. EL CAMINO REAL SUITE 4
MOUNTAIN VIEW CA
94040-1632
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 Number3294
License Number StateCA

VIII. Authorized Official

Name: DR. BRENT ANDREW HALEY
Title or Position: DOCTOR/OWNER/PRESIDENT
Credential: D.C.
Phone: 650-967-1152