Provider Demographics
NPI:1396515508
Name:HAISLIP CHIROPRACTIC INC.
Entity type:Organization
Organization Name:HAISLIP CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TANNER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAISLIP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-663-3878
Mailing Address - Street 1:24901 HOMESTEAD LN
Mailing Address - Street 2:
Mailing Address - City:ACAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:95220-9467
Mailing Address - Country:US
Mailing Address - Phone:209-365-3248
Mailing Address - Fax:
Practice Address - Street 1:3200 E EIGHT MILE RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-9414
Practice Address - Country:US
Practice Address - Phone:209-365-3248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty