Provider Demographics
NPI:1467232124
Name:HAUN, TIM MITCHELL (DC)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:MITCHELL
Last Name:HAUN
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 1:221 N RENGSTORFF AVE APT 21
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-4251
Mailing Address - Country:US
Mailing Address - Phone:408-605-2228
Mailing Address - Fax:
Practice Address - Street 1:280 N WOLFE RD
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4510
Practice Address - Country:US
Practice Address - Phone:408-605-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor