Provider Demographics
NPI:1225043003
Name:HATHAWAY, RICHARD E JR (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:HATHAWAY
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:2395 N. BECHELLI LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0156
Mailing Address - Country:US
Mailing Address - Phone:530-221-1188
Mailing Address - Fax:530-221-5303
Practice Address - Street 1:2395 N BECHELLI LN
Practice Address - Street 2:SUITE B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0156
Practice Address - Country:US
Practice Address - Phone:530-221-1188
Practice Address - Fax:530-221-5303
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC22705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0227050Medicare PIN
CAU54434Medicare UPIN