Provider Demographics
NPI:1679619167
Name:HAYES, DONOVAN KRISTOPHER (DC)
Entity Type:Individual
Prefix:
First Name:DONOVAN
Middle Name:KRISTOPHER
Last Name:HAYES
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 1:1015 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-0816
Mailing Address - Country:US
Mailing Address - Phone:406-442-4512
Mailing Address - Fax:
Practice Address - Street 1:1015 POPLAR ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-0816
Practice Address - Country:US
Practice Address - Phone:406-442-4512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000041093Medicare UPIN