Provider Demographics
NPI:1346321569
Name:HAWKINS, ANTHONY B (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:B
Last Name:HAWKINS
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 1:7773 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-4950
Mailing Address - Country:US
Mailing Address - Phone:619-465-3000
Mailing Address - Fax:619-465-3003
Practice Address - Street 1:7773 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-4950
Practice Address - Country:US
Practice Address - Phone:619-465-3000
Practice Address - Fax:619-465-3003
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11743111NS0005X
CA111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC11743OtherLICENSE
CAT17176Medicare UPIN