Provider Demographics
NPI:1215634530
Name:HATHAWAY, RYLAND (DC)
Entity type:Individual
Prefix:
First Name:RYLAND
Middle Name:
Last Name:HATHAWAY
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 1:2916 NEDERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-7019
Mailing Address - Country:US
Mailing Address - Phone:409-722-3231
Mailing Address - Fax:409-722-7726
Practice Address - Street 1:2916 NEDERLAND AVE
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-7019
Practice Address - Country:US
Practice Address - Phone:409-722-3231
Practice Address - Fax:409-722-7726
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor