Provider Demographics
NPI:1134167778
Name:HAUSRATH, LYNN M (DC)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:M
Last Name:HAUSRATH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 MACDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-2229
Mailing Address - Country:US
Mailing Address - Phone:510-236-4473
Mailing Address - Fax:510-236-0921
Practice Address - Street 1:3919 MACDONALD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2229
Practice Address - Country:US
Practice Address - Phone:510-236-4473
Practice Address - Fax:510-236-0921
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0171800Medicare ID - Type UnspecifiedPHYS/SUPL CODE