Provider Demographics
NPI:1518010271
Name:HAYNES, JONATHAN NOAH (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:NOAH
Last Name:HAYNES
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 1:83 W YELLOW BEE DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85243-4828
Mailing Address - Country:US
Mailing Address - Phone:480-782-0573
Mailing Address - Fax:
Practice Address - Street 1:19035 E SAN TAN BLVD STE 110
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242-7177
Practice Address - Country:US
Practice Address - Phone:480-882-2400
Practice Address - Fax:480-882-2424
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7375111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor