Provider Demographics
NPI:1760590772
Name:HATT, MARVIN KAY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:KAY
Last Name:HATT
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:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83211-0308
Mailing Address - Country:US
Mailing Address - Phone:208-226-2338
Mailing Address - Fax:
Practice Address - Street 1:2842A POCATELLO AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:AMERICAN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83211-0308
Practice Address - Country:US
Practice Address - Phone:208-226-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC5519OtherBLUE CROSS
ID000010008072OtherBLUE SHIELD
ID000010008072OtherBLUE SHIELD
IDC5519OtherBLUE CROSS