Provider Demographics
NPI:1972693430
Name:HALEY CHIROPRACTIC LIFE CENTER
Entity Type:Organization
Organization Name:HALEY CHIROPRACTIC LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-589-2222
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:AR
Mailing Address - Zip Code:72131-0335
Mailing Address - Country:US
Mailing Address - Phone:501-589-2222
Mailing Address - Fax:501-589-2222
Practice Address - Street 1:5 NEW ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:AR
Practice Address - Zip Code:72131-8607
Practice Address - Country:US
Practice Address - Phone:501-589-2222
Practice Address - Fax:501-589-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR112370718Medicaid
T20633Medicare UPIN
AR5B140Medicare ID - Type Unspecified