Provider Demographics
NPI:1306424205
Name:TAYLOR, HAILEY FAY
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:FAY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-0203
Mailing Address - Country:US
Mailing Address - Phone:509-935-2225
Mailing Address - Fax:
Practice Address - Street 1:103 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-8960
Practice Address - Country:US
Practice Address - Phone:509-935-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00033990111N00000X
WA61039173225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1942309687OtherCHIROPRACTIC
WA1427045566OtherCHIROPRACTIC BILLING