Provider Demographics
NPI:1356563647
Name:HAAKE, CURTIS J (DC)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:J
Last Name:HAAKE
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 1:3011 CITRUS CIR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2690
Mailing Address - Country:US
Mailing Address - Phone:925-930-7902
Mailing Address - Fax:925-947-1007
Practice Address - Street 1:3011 CITRUS CIR STE 102
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-930-7902
Practice Address - Fax:925-947-1007
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27331111N00000X
CA27330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27331OtherCHIROPRACTIC LICENSE #