Provider Demographics
NPI:1235677949
Name:HAUPTMAN, JAY H (DC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:H
Last Name:HAUPTMAN
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 1:3230 S EISENHOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-7818
Mailing Address - Country:US
Mailing Address - Phone:903-465-1881
Mailing Address - Fax:903-463-4070
Practice Address - Street 1:1004 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3016
Practice Address - Country:US
Practice Address - Phone:580-448-4412
Practice Address - Fax:580-448-4413
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016044965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor