Healthcare Provider Details

I. General information

NPI: 1972693430
Provider Name (Legal Business Name): HALEY CHIROPRACTIC LIFE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 NEW ST
QUITMAN AR
72131-8607
US

IV. Provider business mailing address

PO BOX 335
QUITMAN AR
72131-0335
US

V. Phone/Fax

Practice location:
  • Phone: 501-589-2222
  • Fax: 501-589-2222
Mailing address:
  • Phone: 501-589-2222
  • Fax: 501-589-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number927
License Number StateAR

VIII. Authorized Official

Name: MRS. SUSAN DENISE HALEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 501-589-2222