Provider Demographics
NPI:1366412447
Name:HATHCOCK, RICHARD N (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:N
Last Name:HATHCOCK
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 1:4968 WILLIAM ARNOLD RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4238
Mailing Address - Country:US
Mailing Address - Phone:901-767-8077
Mailing Address - Fax:901-767-8861
Practice Address - Street 1:4968 WILLIAM ARNOLD RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4238
Practice Address - Country:US
Practice Address - Phone:901-767-8077
Practice Address - Fax:901-767-8861
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU92400Medicare UPIN
TN9372733Medicare ID - Type Unspecified