Provider Demographics
NPI:1093844565
Name:HALEY, BRENT ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ANDREW
Last Name:HALEY
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 1:5050 EL CAMINO REAL
Mailing Address - Street 2:STE 112
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1531
Mailing Address - Country:US
Mailing Address - Phone:650-967-1152
Mailing Address - Fax:650-967-5328
Practice Address - Street 1:2290 W EL CAMINO REAL
Practice Address - Street 2:SUITE 4
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-1631
Practice Address - Country:US
Practice Address - Phone:650-967-1152
Practice Address - Fax:650-967-5328
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC022694Medicare ID - Type UnspecifiedMEDICARE ID