Provider Demographics
NPI:1043275217
Name:HAYDON, PATRICIA D (DC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:D
Last Name:HAYDON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 AIRWAY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3669
Mailing Address - Country:US
Mailing Address - Phone:928-757-2800
Mailing Address - Fax:928-757-2772
Practice Address - Street 1:2139 AIRWAY AVE.
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3669
Practice Address - Country:US
Practice Address - Phone:928-757-2800
Practice Address - Fax:928-757-2772
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT41699Medicare UPIN
AZZ35WCKDM02Medicare PIN