Provider Demographics
NPI:1265768626
Name:HAYNES FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:HAYNES FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:931-380-3001
Mailing Address - Street 1:710 HATCHER LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3522
Mailing Address - Country:US
Mailing Address - Phone:931-380-3001
Mailing Address - Fax:931-380-3012
Practice Address - Street 1:710 HATCHER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3522
Practice Address - Country:US
Practice Address - Phone:931-380-3001
Practice Address - Fax:931-380-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC582111N00000X
TNDC584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT74684Medicare UPIN
TNT74682Medicare UPIN