Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3089-012 | WI |
NPI | 1003973108 |
---|---|
Provider Name | Dr. Toby Jayne Hawkes |
First Address | Paddock Lake, WI 53168 |
Second Address | Paddock Lake, WI 53168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |