Provider Demographics
NPI:1831254440
Name:HAYES, BREECE WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:BREECE
Middle Name:WAYNE
Last Name:HAYES
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:PO BOX 864
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-0864
Mailing Address - Country:US
Mailing Address - Phone:606-787-0441
Mailing Address - Fax:
Practice Address - Street 1:417 MIDDLEBURG ST.
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539-0819
Practice Address - Country:US
Practice Address - Phone:606-787-7261
Practice Address - Fax:606-787-5830
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000859Medicaid
KY85000859Medicaid
KYU77062Medicare UPIN