Provider Demographics
NPI:1457760951
Name:COONRAD, HAILEY D (DC)
Entity Type:Individual
Prefix:DR
First Name:HAILEY
Middle Name:D
Last Name:COONRAD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 FROM RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3500
Mailing Address - Country:US
Mailing Address - Phone:201-634-9004
Mailing Address - Fax:201-634-9690
Practice Address - Street 1:625 FROM RD
Practice Address - Street 2:SUITE 10
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3500
Practice Address - Country:US
Practice Address - Phone:201-634-9004
Practice Address - Fax:201-634-9690
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00719000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor