Provider Demographics
NPI:1528567153
Name:HATALLA, ANDREW (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:HATALLA
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 1:593A CLARK STREET RD
Mailing Address - Street 2:
Mailing Address - City:CAYUGA
Mailing Address - State:NY
Mailing Address - Zip Code:13034-2117
Mailing Address - Country:US
Mailing Address - Phone:315-297-0376
Mailing Address - Fax:
Practice Address - Street 1:593A CLARK STREET RD
Practice Address - Street 2:
Practice Address - City:CAYUGA
Practice Address - State:NY
Practice Address - Zip Code:13034-2117
Practice Address - Country:US
Practice Address - Phone:315-297-0376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX013069-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor