Provider Demographics
NPI:1063500171
Name:HATHAWAY, DONNA S (DC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:S
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 E 21ST STREET
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-1409
Mailing Address - Country:US
Mailing Address - Phone:918-665-1120
Mailing Address - Fax:
Practice Address - Street 1:8501 E 21ST STREET
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-1409
Practice Address - Country:US
Practice Address - Phone:918-665-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731343913OtherGALLAGHER BASSETT
OK0005582332OtherAETNA
OK731343913OtherHEALTH CHOICE
OK731343913OtherFIRST HEALTH
T75339Medicare UPIN