Provider Demographics
NPI:1992767875
Name:HAYS, WALLACE HADEN (DC)
Entity type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:HADEN
Last Name:HAYS
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 1:3111 JENNY LIND RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-6738
Mailing Address - Country:US
Mailing Address - Phone:479-783-0779
Mailing Address - Fax:479-782-6442
Practice Address - Street 1:3111 JENNY LIND RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-6738
Practice Address - Country:US
Practice Address - Phone:479-783-0779
Practice Address - Fax:479-782-6442
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1841111N00000X
AR929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F180OtherBLUE CROSS/BLUE SHIELD
ART20638Medicare UPIN
AR59363Medicare ID - Type Unspecified