Healthcare Provider Details

I. General information

NPI: 1932106770
Provider Name (Legal Business Name): CHARLES MITCHELL HAYMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 W LOCUST ST
BOONVILLE IN
47601-1525
US

IV. Provider business mailing address

423 W LOCUST ST
BOONVILLE IN
47601-1525
US

V. Phone/Fax

Practice location:
  • Phone: 812-897-8000
  • Fax: 812-897-4922
Mailing address:
  • Phone: 812-897-8000
  • Fax: 812-897-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001860A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: