Provider Demographics
NPI:1881770188
Name:HAEZEBROUCK, JOSEPH VANCE (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:VANCE
Last Name:HAEZEBROUCK
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 1:3417 CANTON RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2896
Mailing Address - Country:US
Mailing Address - Phone:770-424-5551
Mailing Address - Fax:770-424-5553
Practice Address - Street 1:3417 CANTON RD STE 301
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2896
Practice Address - Country:US
Practice Address - Phone:770-424-5551
Practice Address - Fax:770-424-5553
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002035111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1902033343OtherLIFE UNIVERSITY C-HOP
GA35ZCGMFMedicare ID - Type UnspecifiedPROVIDER NUMBER