Provider Demographics
NPI:1003973108
Name:HAWKES, TOBY JAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:TOBY
Middle Name:JAYNE
Last Name:HAWKES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24706 75TH ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PADDOCK LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53168
Mailing Address - Country:US
Mailing Address - Phone:262-843-1939
Mailing Address - Fax:
Practice Address - Street 1:24706 75TH ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:PADDOCK LAKE
Practice Address - State:WI
Practice Address - Zip Code:53168
Practice Address - Country:US
Practice Address - Phone:262-843-1939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3089-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35242Medicare ID - Type Unspecified