Provider Demographics
NPI:1134222508
Name:HARDIN, HARRELL DEAN (DC)
Entity type:Individual
Prefix:MR
First Name:HARRELL
Middle Name:DEAN
Last Name:HARDIN
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 1:1548 UNION RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054
Mailing Address - Country:US
Mailing Address - Phone:704-861-0707
Mailing Address - Fax:704-861-1996
Practice Address - Street 1:1548 UNION RD
Practice Address - Street 2:SUITE D
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054
Practice Address - Country:US
Practice Address - Phone:704-861-0707
Practice Address - Fax:704-861-1996
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2422111N00000X
SC2131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U68511Medicare UPIN
2451727AMedicare ID - Type Unspecified