Provider Demographics
NPI:1992586630
Name:HEATH, HAYLIE (DC)
Entity type:Individual
Prefix:
First Name:HAYLIE
Middle Name:
Last Name:HEATH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 SE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4121
Mailing Address - Country:US
Mailing Address - Phone:503-681-8125
Mailing Address - Fax:
Practice Address - Street 1:156 SE 4TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4121
Practice Address - Country:US
Practice Address - Phone:503-681-8125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor