Provider Demographics
NPI:1255345476
Name:HATHAWAY, JARED STEPHEN (DC)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:STEPHEN
Last Name:HATHAWAY
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 1:1664 KIRBY PKWY.
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120
Mailing Address - Country:US
Mailing Address - Phone:574-527-2283
Mailing Address - Fax:901-454-0606
Practice Address - Street 1:3340 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4692
Practice Address - Country:US
Practice Address - Phone:901-454-1234
Practice Address - Fax:901-454-0606
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN111N00000X111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic