Provider Demographics
NPI:1154569242
Name:HAIMOVITZ, GIDEON I (DC)
Entity type:Individual
Prefix:
First Name:GIDEON
Middle Name:I
Last Name:HAIMOVITZ
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 1:104 CATHERINE LN
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5701
Mailing Address - Country:US
Mailing Address - Phone:530-477-8081
Mailing Address - Fax:
Practice Address - Street 1:104 CATHERINE LN
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5701
Practice Address - Country:US
Practice Address - Phone:530-477-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor