Provider Demographics
NPI:1891872495
Name:HAYES, SHAWN IVAN (DC)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:IVAN
Last Name:HAYES
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 1:750 SPAANS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-8609
Mailing Address - Country:US
Mailing Address - Phone:209-745-6639
Mailing Address - Fax:209-745-5918
Practice Address - Street 1:750 SPAANS DR
Practice Address - Street 2:SUITE A
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-8609
Practice Address - Country:US
Practice Address - Phone:209-745-6639
Practice Address - Fax:209-745-5918
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC198240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU09114Medicare UPIN
CADC0198240Medicare ID - Type Unspecified