Provider Demographics
NPI:1669846374
Name:HAWORTH, DARIN (DC, MS)
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:
Last Name:HAWORTH
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14224
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96151-4224
Mailing Address - Country:US
Mailing Address - Phone:509-331-3698
Mailing Address - Fax:
Practice Address - Street 1:2877 LAKE TAHOE BLVD #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:530-600-3321
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor