Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 1806 | OK |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 1806 | OK |
NPI | 1467480822 |
---|---|
Provider Name | Dr. Brad Monroe Hayes |
First Address | Tulsa, OK 74136-3311 |
Second Address | Tulsa, OK 74136-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 11/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T75197 | (02) | OK |