Provider Demographics
NPI:1861459786
Name:HAFEN, MATTHEW T (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:T
Last Name:HAFEN
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 1:1173 S 250 W
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6178
Mailing Address - Country:US
Mailing Address - Phone:435-673-0900
Mailing Address - Fax:435-673-1606
Practice Address - Street 1:1173 S 250 W
Practice Address - Street 2:SUITE 107
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6178
Practice Address - Country:US
Practice Address - Phone:435-673-0900
Practice Address - Fax:435-673-1606
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9761461202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTV08437Medicare UPIN