Provider Demographics
NPI:1093711434
Name:HATRAK, JOSEPH E (CA, LA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:E
Last Name:HATRAK
Suffix:
Gender:M
Credentials:CA, LA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 JACKSON RD
Mailing Address - Street 2:STE A1
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9279
Mailing Address - Country:US
Mailing Address - Phone:609-654-2420
Mailing Address - Fax:609-654-4261
Practice Address - Street 1:30 JACKSON RD
Practice Address - Street 2:STE A1
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9279
Practice Address - Country:US
Practice Address - Phone:609-654-2420
Practice Address - Fax:609-654-4261
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00265600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor