Provider Demographics
NPI:1477234078
Name:HAISLIP, TANNER (DC)
Entity Type:Individual
Prefix:DR
First Name:TANNER
Middle Name:
Last Name:HAISLIP
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 1:1401 21ST ST STE 5099
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-5226
Mailing Address - Country:US
Mailing Address - Phone:209-663-3878
Mailing Address - Fax:
Practice Address - Street 1:24901 HOMESTEAD LN
Practice Address - Street 2:
Practice Address - City:ACAMPO
Practice Address - State:CA
Practice Address - Zip Code:95220-9467
Practice Address - Country:US
Practice Address - Phone:209-663-3878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor