Provider Demographics
NPI:1689641177
Name:HAZELBAKER, CHADRON B (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:CHADRON
Middle Name:B
Last Name:HAZELBAKER
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5129 S MYRTLE LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7857
Mailing Address - Country:US
Mailing Address - Phone:509-448-4738
Mailing Address - Fax:
Practice Address - Street 1:5129 S MYRTLE LN
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-7857
Practice Address - Country:US
Practice Address - Phone:509-448-4738
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other