Provider Demographics
NPI:1558991141
Name:SUMMIT TO SHORE CHIROPRACTIC A HAWORTH CORPORATION
Entity Type:Organization
Organization Name:SUMMIT TO SHORE CHIROPRACTIC A HAWORTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HAWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-544-8495
Mailing Address - Street 1:2877 LAKE TAHOE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7807
Mailing Address - Country:US
Mailing Address - Phone:530-544-8495
Mailing Address - Fax:
Practice Address - Street 1:2877 LAKE TAHOE BLVD STE E
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7807
Practice Address - Country:US
Practice Address - Phone:530-544-8495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty