Provider Demographics
NPI:1356607899
Name:HAYNES, CHRISTINE ANN (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ANN
Last Name:HAYNES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ANN
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1519 S RESERVE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4755
Mailing Address - Country:US
Mailing Address - Phone:563-212-9244
Mailing Address - Fax:
Practice Address - Street 1:1519 S RESERVE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4755
Practice Address - Country:US
Practice Address - Phone:406-549-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor