Provider Demographics
NPI:1215204102
Name:DR PAUL HYER CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:DR PAUL HYER CHIROPRACTIC CORPORATION
Other - Org Name:MESA CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-379-3425
Mailing Address - Street 1:2810 NUGGET AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93240-9494
Mailing Address - Country:US
Mailing Address - Phone:760-379-3425
Mailing Address - Fax:
Practice Address - Street 1:2810 NUGGET AVE
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240-9494
Practice Address - Country:US
Practice Address - Phone:760-379-3425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24797261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center