Provider Demographics
NPI:1093270688
Name:HAYNES, TIMOTHY LORNE (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LORNE
Last Name:HAYNES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3775 BEACON AVE.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-371-5124
Mailing Address - Fax:949-655-7873
Practice Address - Street 1:3775 BEACON AVE.
Practice Address - Street 2:SUITE 200
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-371-5124
Practice Address - Fax:949-655-7873
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC34285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor