Provider Demographics
NPI:1154473551
Name:HALEY, MICHAEL A (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:HALEY
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 1:421 SE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-8012
Mailing Address - Country:US
Mailing Address - Phone:954-969-8800
Mailing Address - Fax:
Practice Address - Street 1:500 S CYPRESS RD
Practice Address - Street 2:#4
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7141
Practice Address - Country:US
Practice Address - Phone:954-969-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55510OtherBLUE CROSS BLUE SHIELD