Provider Demographics
NPI:1669613626
Name:HALEY - CARR SPINAL & SPORTS CARE CHIROPRACTIC CENTER, INC.
Entity type:Organization
Organization Name:HALEY - CARR SPINAL & SPORTS CARE CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-967-1152
Mailing Address - Street 1:2290 W. EL CAMINO REAL
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1632
Mailing Address - Country:US
Mailing Address - Phone:650-967-1152
Mailing Address - Fax:650-967-5328
Practice Address - Street 1:2290 W EL CAMINO REAL
Practice Address - Street 2:SUITE 4
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-1631
Practice Address - Country:US
Practice Address - Phone:650-967-1152
Practice Address - Fax:650-967-5328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty