Provider Demographics
NPI:1902868623
Name:.HANEY CHIROPRACTICPC.
Entity Type:Organization
Organization Name:.HANEY CHIROPRACTICPC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ALYCE
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-660-5262
Mailing Address - Street 1:36734 AVENUE 12
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8774
Mailing Address - Country:US
Mailing Address - Phone:559-660-5262
Mailing Address - Fax:559-800-7072
Practice Address - Street 1:36734 AVENUE 12
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8774
Practice Address - Country:US
Practice Address - Phone:559-660-5262
Practice Address - Fax:559-800-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28490111N00000X
CADC28489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA276058OtherBLUE CROSS
PA276058OtherBLUE CROSS