Provider Demographics
NPI:1366218034
Name:HANEY, CALISSA MICHAELA (DC)
Entity type:Individual
Prefix:
First Name:CALISSA
Middle Name:MICHAELA
Last Name:HANEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CALISSA
Other - Middle Name:MICHAELA
Other - Last Name:HANEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:9439 N SAYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0765
Mailing Address - Country:US
Mailing Address - Phone:559-269-3256
Mailing Address - Fax:
Practice Address - Street 1:7111 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2965
Practice Address - Country:US
Practice Address - Phone:559-878-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor