Provider Demographics
NPI:1043400823
Name:HATCH, SHAWN SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:SCOTT
Last Name:HATCH
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:PO BOX 65695
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-0024
Mailing Address - Country:US
Mailing Address - Phone:971-409-5111
Mailing Address - Fax:
Practice Address - Street 1:2900 NE 132ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-3014
Practice Address - Country:US
Practice Address - Phone:503-251-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3910111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician