Provider Demographics
NPI:1891084471
Name:WALLACE HAYS FAMILY CHIROPRACTIC CLINIC, PA
Entity Type:Organization
Organization Name:WALLACE HAYS FAMILY CHIROPRACTIC CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-783-0779
Mailing Address - Street 1:PO BOX 3996
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72913-3996
Mailing Address - Country:US
Mailing Address - Phone:479-783-0779
Mailing Address - Fax:479-782-6442
Practice Address - Street 1:3111 JENNY LIND RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-6738
Practice Address - Country:US
Practice Address - Phone:479-783-0779
Practice Address - Fax:479-782-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR929261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
59363Medicare PIN