Provider Demographics
NPI:1801306717
Name:HAYNES, BENJAMIN (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:HAYNES
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 1:19315 W CATAWBA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5637
Mailing Address - Country:US
Mailing Address - Phone:704-896-1811
Mailing Address - Fax:704-896-1812
Practice Address - Street 1:19315 W CATAWBA AVE STE 100
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5637
Practice Address - Country:US
Practice Address - Phone:704-896-1811
Practice Address - Fax:704-896-1812
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor