Provider Demographics
NPI:1952366783
Name:HALEY, MARK A (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:HALEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 N PEARL ST
Mailing Address - Street 2:A4
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2461
Mailing Address - Country:US
Mailing Address - Phone:253-761-0930
Mailing Address - Fax:253-761-8746
Practice Address - Street 1:1919 N PEARL ST
Practice Address - Street 2:A4
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2461
Practice Address - Country:US
Practice Address - Phone:253-761-0930
Practice Address - Fax:253-761-8746
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician