Provider Demographics
NPI:1013933001
Name:HAYNES, MARK JONATHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JONATHAN
Last Name:HAYNES
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 1:670 KING PARK DR
Mailing Address - Street 2:STE 1
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6257
Mailing Address - Country:US
Mailing Address - Phone:406-655-4940
Mailing Address - Fax:406-655-4944
Practice Address - Street 1:670 KING PARK DR
Practice Address - Street 2:STE 1
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6257
Practice Address - Country:US
Practice Address - Phone:406-655-4940
Practice Address - Fax:406-655-4944
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1115111N00000X
CADC25010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor