Provider Demographics
NPI:1588625115
Name:HALEY, SAMUEL SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:SCOTT
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:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:AR
Mailing Address - Zip Code:72131-0335
Mailing Address - Country:US
Mailing Address - Phone:501-589-2222
Mailing Address - Fax:501-589-2222
Practice Address - Street 1:5 NEW ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:AR
Practice Address - Zip Code:72131-8607
Practice Address - Country:US
Practice Address - Phone:501-589-2222
Practice Address - Fax:501-589-2222
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104943718Medicaid
AR59350Medicare ID - Type UnspecifiedPROVIDER NUMBER
ART20633Medicare UPIN