Provider Demographics
NPI:1740249812
Name:HALOUZKA, MARY ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:HALOUZKA
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 1:10025 CARMEL MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3229
Mailing Address - Country:US
Mailing Address - Phone:858-484-0279
Mailing Address - Fax:
Practice Address - Street 1:10025 CARMEL MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-3229
Practice Address - Country:US
Practice Address - Phone:858-484-0279
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20615111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician