Provider Demographics
NPI:1932106770
Name:HAYMAN, CHARLES MITCHELL (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MITCHELL
Last Name:HAYMAN
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 1:423 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-1525
Mailing Address - Country:US
Mailing Address - Phone:812-897-8000
Mailing Address - Fax:812-897-4922
Practice Address - Street 1:423 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-1525
Practice Address - Country:US
Practice Address - Phone:812-897-8000
Practice Address - Fax:812-897-4922
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001860A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200208140AMedicaid
IN200208140AMedicaid
IN146320Medicare ID - Type Unspecified