Provider Demographics
NPI:1760534960
Name:HADLEY, HARRY L JR (DC)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:L
Last Name:HADLEY
Suffix:JR
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 1:6440 ALPINE AVE NW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-8002
Mailing Address - Country:US
Mailing Address - Phone:616-419-3399
Mailing Address - Fax:616-419-3371
Practice Address - Street 1:6440 ALPINE AVE NW
Practice Address - Street 2:SUITE 2
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-8002
Practice Address - Country:US
Practice Address - Phone:616-419-3399
Practice Address - Fax:616-419-3371
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007976111NX0800X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIHH007976Medicaid
MI144285446Medicaid
MI133481OtherPREFERRED CHOICES
MI950H15093OtherBLUE CROSS BLUE SHIELD
MIU80361Medicare UPIN
MIHH007976Medicaid
MION11440Medicare ID - Type UnspecifiedCHIROPRACTIC