Provider Demographics
NPI:1891804753
Name:HAFER, WILLIAM J (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:HAFER
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 1:163 W PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:NEW STANTON
Mailing Address - State:PA
Mailing Address - Zip Code:15672-9474
Mailing Address - Country:US
Mailing Address - Phone:724-925-2244
Mailing Address - Fax:
Practice Address - Street 1:163 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:NEW STANTON
Practice Address - State:PA
Practice Address - Zip Code:15672-9474
Practice Address - Country:US
Practice Address - Phone:724-925-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005358L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018016OtherASHN
PA86284Medicaid
PA409060OtherHEALTH AMERICA
PA1509124Medicaid
PA0014474600001Medicaid
PA1355536OtherBLUE CROSS/ BLUE SHIELD
PA756009JE6Medicare ID - Type Unspecified
PA1018016OtherASHN
PA86284Medicaid
PA0014474600001Medicaid