Provider Demographics
NPI:1174967038
Name:GIRARD, HALEY BLAKE (DC)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:BLAKE
Last Name:GIRARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:BLAKE
Other - Last Name:FERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:959 CONGRESS ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2715
Mailing Address - Country:US
Mailing Address - Phone:207-699-5600
Mailing Address - Fax:207-699-5588
Practice Address - Street 1:959 CONGRESS ST STE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2715
Practice Address - Country:US
Practice Address - Phone:207-699-5600
Practice Address - Fax:207-699-5588
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2158111N00000X, 111NN0400X
RIDCP00625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
003225901Medicare PIN