Provider Demographics
NPI:1013077155
Name:CHIROPRACTIC WORKS, INC
Entity Type:Organization
Organization Name:CHIROPRACTIC WORKS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-609-0399
Mailing Address - Street 1:32475 CLINTON KEITH RD
Mailing Address - Street 2:#108
Mailing Address - City:BALTIMORE
Mailing Address - State:CA
Mailing Address - Zip Code:92595-8664
Mailing Address - Country:US
Mailing Address - Phone:951-609-0399
Mailing Address - Fax:951-609-0239
Practice Address - Street 1:32475 CLINTON KEITH RD
Practice Address - Street 2:#108
Practice Address - City:BALTIMORE
Practice Address - State:CA
Practice Address - Zip Code:92595-8664
Practice Address - Country:US
Practice Address - Phone:951-609-0399
Practice Address - Fax:951-609-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC1019825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0198250Medicare ID - Type Unspecified
T89994Medicare UPIN