Provider Demographics
NPI:1841226180
Name:HAYNIE, DEDRA N (DC)
Entity Type:Individual
Prefix:DR
First Name:DEDRA
Middle Name:N
Last Name:HAYNIE
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 1:793 S DOWNING ST
Mailing Address - Street 2:APT 3
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4464
Mailing Address - Country:US
Mailing Address - Phone:303-777-2640
Mailing Address - Fax:
Practice Address - Street 1:2760 S HAVANA ST
Practice Address - Street 2:SUITE O
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-8602
Practice Address - Country:US
Practice Address - Phone:303-338-8388
Practice Address - Fax:303-369-8452
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-5400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor