Provider Demographics
NPI:1578524039
Name:HAYDEL, PATRICK SAMUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:SAMUEL
Last Name:HAYDEL
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 1:501 BARROW ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4605
Mailing Address - Country:US
Mailing Address - Phone:985-872-1133
Mailing Address - Fax:985-872-6325
Practice Address - Street 1:501 BARROW ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4605
Practice Address - Country:US
Practice Address - Phone:985-872-1133
Practice Address - Fax:985-872-6325
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU51444Medicare UPIN