Provider Demographics
NPI:1093882482
Name:HAYNES, KATHRYN ELISABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ELISABETH
Last Name:HAYNES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ELISABETH
Other - Last Name:CASERTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:25 N. MARKET ST.
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-3903
Mailing Address - Country:US
Mailing Address - Phone:423-265-2225
Mailing Address - Fax:423-265-3111
Practice Address - Street 1:25 N. MARKET ST.
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3903
Practice Address - Country:US
Practice Address - Phone:423-265-2225
Practice Address - Fax:423-265-3111
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3973237Medicaid
TN3973237Medicare ID - Type UnspecifiedMEDICARE
TN3973237Medicaid