Provider Demographics
NPI:1205600863
Name:HAVEN CHIROPRACTIC CARE, PC
Entity type:Organization
Organization Name:HAVEN CHIROPRACTIC CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-799-0690
Mailing Address - Street 1:102 WILLOW DR STE A
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1073
Mailing Address - Country:US
Mailing Address - Phone:618-799-0690
Mailing Address - Fax:
Practice Address - Street 1:102 WILLOW DR STE A
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1073
Practice Address - Country:US
Practice Address - Phone:618-799-0690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center