Provider Demographics
NPI:1619980075
Name:HANELINE, WILLIAM J (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:HANELINE
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 1:600 CENTRAL AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2740
Mailing Address - Country:US
Mailing Address - Phone:951-595-1502
Mailing Address - Fax:951-746-2332
Practice Address - Street 1:600 CENTRAL AVE
Practice Address - Street 2:SUITE G
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2740
Practice Address - Country:US
Practice Address - Phone:951-595-1502
Practice Address - Fax:951-746-2332
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor