Provider Demographics
NPI:1336398189
Name:HALES, NATHAN (DC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:HALES
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 1:360 S STATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1892
Mailing Address - Country:US
Mailing Address - Phone:801-773-1821
Mailing Address - Fax:
Practice Address - Street 1:360 S STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1892
Practice Address - Country:US
Practice Address - Phone:801-773-1821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6961497-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor