Provider Demographics
NPI:1720132228
Name:MARK J HAYNES A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:MARK J HAYNES A PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:MONTANA PAIN & REHAB CENTER/MONTANA WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNERPRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-655-4940
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty