Provider Demographics
NPI:1952599425
Name:HAILEY CHIROPRACTIC
Entity Type:Organization
Organization Name:HAILEY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-290-0371
Mailing Address - Street 1:82 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:VA
Mailing Address - Zip Code:24465
Mailing Address - Country:US
Mailing Address - Phone:540-290-0371
Mailing Address - Fax:
Practice Address - Street 1:82 WILSON AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:VA
Practice Address - Zip Code:24465
Practice Address - Country:US
Practice Address - Phone:540-290-0371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556252261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV02570Medicare UPIN