Healthcare Provider Details

I. General information

NPI: 1952599425
Provider Name (Legal Business Name): HAILEY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 WILSON AVE
MONTEREY VA
24465
US

IV. Provider business mailing address

82 WILSON AVE
MONTEREY VA
24465
US

V. Phone/Fax

Practice location:
  • Phone: 540-290-0371
  • Fax:
Mailing address:
  • Phone: 540-290-0371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number0104556252
License Number StateVA

VIII. Authorized Official

Name: DR. ANDREA LYNN HAILEY
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 540-290-0371