Provider Demographics
NPI:1649588898
Name:HAYES, CONNIE S (DC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:S
Last Name:HAYES
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 1:210 TRIAD CTR W
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-7543
Mailing Address - Country:US
Mailing Address - Phone:636-542-4044
Mailing Address - Fax:636-489-1154
Practice Address - Street 1:210 TRIAD CTR W
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-7543
Practice Address - Country:US
Practice Address - Phone:636-542-4044
Practice Address - Fax:636-489-1154
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002030437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor