Provider Demographics
NPI:1104024934
Name:HAVEN CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:HAVEN CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LAURENCE
Authorized Official - Last Name:VEIRS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-945-9982
Mailing Address - Street 1:8045 VINEYARD AVE
Mailing Address - Street 2:STE I-9
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-2300
Mailing Address - Country:US
Mailing Address - Phone:909-945-9982
Mailing Address - Fax:909-945-9929
Practice Address - Street 1:8045 VINEYARD AVE
Practice Address - Street 2:STE I-9
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-2300
Practice Address - Country:US
Practice Address - Phone:909-945-9982
Practice Address - Fax:909-945-9929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty