Provider Demographics
NPI:1356440945
Name:HAILEY, ANDREA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LYNN
Last Name:HAILEY
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 1:436 S LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-3564
Mailing Address - Country:US
Mailing Address - Phone:540-248-3210
Mailing Address - Fax:540-416-0243
Practice Address - Street 1:436 S LINDEN AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3564
Practice Address - Country:US
Practice Address - Phone:540-248-3210
Practice Address - Fax:540-416-0243
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV02570Medicare UPIN