Provider Demographics
NPI:1467480822
Name:HAYES, BRAD MONROE (DC)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:MONROE
Last Name:HAYES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6717 S YALE AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3311
Mailing Address - Country:US
Mailing Address - Phone:918-492-0087
Mailing Address - Fax:918-496-0952
Practice Address - Street 1:6717 S YALE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3311
Practice Address - Country:US
Practice Address - Phone:918-492-0087
Practice Address - Fax:918-496-0952
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1806111NX0800X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQDCDZMedicare ID - Type Unspecified
OKT75197Medicare UPIN