Provider Demographics
NPI:1740861459
Name:THOMAS, HAYLEY ALYSSA (DC)
Entity type:Individual
Prefix:
First Name:HAYLEY
Middle Name:ALYSSA
Last Name:THOMAS
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 1:4937 W 119TH ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2718
Mailing Address - Country:US
Mailing Address - Phone:607-426-5909
Mailing Address - Fax:
Practice Address - Street 1:18600 MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1715
Practice Address - Country:US
Practice Address - Phone:714-794-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor