Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038011064 | IL |
NPI | 1003091380 |
---|---|
Provider Name | Dr. John R Hayden |
First Address | Apollo Beach, FL 33572 |
Second Address | Apollo Beach, FL 33572 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2008 |
Last Update Date | 14/10/2010 |