Provider Demographics
NPI:1275704488
Name:SPINAL & SPORTS CARE CENTER
Entity Type:Organization
Organization Name:SPINAL & SPORTS CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-967-1152
Mailing Address - Street 1:2290 W EL CAMINO REAL
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1631
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty