Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 111N00000X | TN |
NPI | 1255345476 |
---|---|
Provider Name | Dr. Jared Stephen Hathaway |
First Address | Memphis, TN 38120 |
Second Address | Memphis, TN 38111-4692 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |