Healthcare Provider Details

I. General information

NPI: 1790050086
Provider Name (Legal Business Name): HAYES CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 STEVENS AVE
PORTLAND ME
04103-2623
US

IV. Provider business mailing address

808 STEVENS AVE
PORTLAND ME
04103-2623
US

V. Phone/Fax

Practice location:
  • Phone: 207-797-5868
  • Fax: 207-797-5868
Mailing address:
  • Phone: 207-797-5868
  • Fax: 207-797-5868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCR570
License Number StateME

VIII. Authorized Official

Name: DR. JOHN F. HAYES III
Title or Position: PRESIDENT
Credential: D.C.
Phone: 207-797-5868