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General NPI Number Information
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NPI Number | 1740479625
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Entity Type | Organization
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Legal Business Name | M E HALOUZKA DC PC
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 12348 CREEKVIEW DRIVE
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City | SAN DIEGO
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State | CA
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Zip | 92128
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Country | US
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Telephone | 858-391-0434
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Fax |
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Provider Business Mailing Address
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Address Line | 12348 CREEKVIEW DRIVE
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City | SAN DIEGO
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State | CA
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Zip | 92128
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Country | US
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Telephone | 858-391-0434
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MS. MARY ELIZABETH HALOUZKA
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Credential | DC
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Telephone | 858-391-0434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 20615DC
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 20615
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License Number State | CA
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