Provider Demographics
NPI:1255460242
Name:HAYDEN, DEREK REX (DC)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:REX
Last Name:HAYDEN
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 1:716 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324
Mailing Address - Country:US
Mailing Address - Phone:509-525-7661
Mailing Address - Fax:509-525-7661
Practice Address - Street 1:716 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324
Practice Address - Country:US
Practice Address - Phone:509-525-7661
Practice Address - Fax:509-525-7661
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8852039Medicare ID - Type Unspecified
U95654Medicare UPIN