Provider Demographics
NPI:1538230792
Name:HAYNES, RICHARD LEE (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:HAYNES
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 1:2041 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2959
Mailing Address - Country:US
Mailing Address - Phone:206-325-1575
Mailing Address - Fax:206-328-0514
Practice Address - Street 1:2041 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2959
Practice Address - Country:US
Practice Address - Phone:206-325-1575
Practice Address - Fax:206-328-0514
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2035301Medicaid
WA36122OtherLABOR & INDUSTRIES
WAT01623Medicare UPIN
WAGAB00864Medicare ID - Type Unspecified