Provider Demographics
NPI:1912995366
Name:HAVENS-WREN, DEBORAH K (DC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:K
Last Name:HAVENS-WREN
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 1:1105 GARDENA RD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4645
Mailing Address - Country:US
Mailing Address - Phone:760-942-2593
Mailing Address - Fax:
Practice Address - Street 1:3650 CLAIREMONT DR
Practice Address - Street 2:1-B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5908
Practice Address - Country:US
Practice Address - Phone:858-274-1910
Practice Address - Fax:858-274-1911
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor