Provider Demographics
NPI:1538116256
Name:HATLEN, GARY CARL (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:CARL
Last Name:HATLEN
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 1:3842 E THUNDERBIRD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5768
Mailing Address - Country:US
Mailing Address - Phone:602-443-4423
Mailing Address - Fax:602-765-1788
Practice Address - Street 1:3842 E THUNDERBIRD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5768
Practice Address - Country:US
Practice Address - Phone:602-443-4423
Practice Address - Fax:602-443-4423
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor