Provider Demographics
NPI:1407850951
Name:HATHCOCK, LINDSAY L JR (DC)
Entity type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:L
Last Name:HATHCOCK
Suffix:JR
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:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37364-0001
Mailing Address - Country:US
Mailing Address - Phone:423-472-0606
Mailing Address - Fax:423-476-1262
Practice Address - Street 1:423 CENTRAL AVE NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-4923
Practice Address - Country:US
Practice Address - Phone:423-472-0606
Practice Address - Fax:423-476-1262
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3673744Medicaid
TN3673744Medicaid
TNT74617Medicare UPIN