Provider Demographics
NPI:1104154731
Name:DR KALA R HATCH PA
Entity type:Organization
Organization Name:DR KALA R HATCH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KALA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-508-4111
Mailing Address - Street 1:PO BOX 1934
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-1934
Mailing Address - Country:US
Mailing Address - Phone:870-508-4111
Mailing Address - Fax:870-424-3761
Practice Address - Street 1:230 HWY 5 NORTH
Practice Address - Street 2:SUITE #10
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653
Practice Address - Country:US
Practice Address - Phone:870-508-4111
Practice Address - Fax:870-424-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139112718Medicaid
AR5U393OtherBLUE CROSS BLUE SHIELD
AR350046599OtherRAILROAD MEDICARE
AR139112718Medicaid
AR5U393Medicare PIN