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General NPI Number Information
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NPI Number | 1811595762
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Entity Type | Organization
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Legal Business Name | HAYNES CHIROPRACTIC
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Dates
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Enumeration Date | 10/13/2020
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 3775 BEACON AVE STE 200
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City | FREMONT
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State | CA
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Zip | 94538-1466
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Country | US
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Telephone | 501-371-5124
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Fax | 949-655-7873
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Provider Business Mailing Address
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Address Line | 3775 BEACON AVE STE 200
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City | FREMONT
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State | CA
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Zip | 94538-1466
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Country | US
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Telephone | 501-371-5124
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Fax | 949-655-7873
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY LORNE HAYNES
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Credential | D.C.
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Telephone | 510-371-5124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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