Provider Demographics
NPI:1013948769
Name:CHIRONUTRICISE, LLC.
Entity Type:Organization
Organization Name:CHIRONUTRICISE, LLC.
Other - Org Name:HATLEN FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:HATLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-443-4423
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:602-765-1788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty