Provider Demographics
NPI:1891795530
Name:HADJIYANE, THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:HADJIYANE
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 1:2718 SANTA BARBARA AVE
Mailing Address - Street 2:STE. 107-A
Mailing Address - City:CAYUCOS
Mailing Address - State:CA
Mailing Address - Zip Code:93430-1471
Mailing Address - Country:US
Mailing Address - Phone:805-543-8199
Mailing Address - Fax:
Practice Address - Street 1:1264 HIGUERA ST
Practice Address - Street 2:STE. 107-A
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3124
Practice Address - Country:US
Practice Address - Phone:805-543-8199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC 17167Medicare ID - Type Unspecified
T18491Medicare UPIN