Provider Demographics
NPI:1669547352
Name:DR HILDA HATTAR DC PC
Entity type:Organization
Organization Name:DR HILDA HATTAR DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HATTAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-784-4346
Mailing Address - Street 1:815 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:IL
Mailing Address - Zip Code:60135-1313
Mailing Address - Country:US
Mailing Address - Phone:815-784-4346
Mailing Address - Fax:815-784-3015
Practice Address - Street 1:815 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:IL
Practice Address - Zip Code:60135-1313
Practice Address - Country:US
Practice Address - Phone:815-784-4346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-008843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01932050OtherBLUE CROSS BLUE SHIELD IL
ILK16441Medicare ID - Type UnspecifiedMEMBER #
IL211429Medicare ID - Type UnspecifiedGROUP PROVIDER
IL01932050OtherBLUE CROSS BLUE SHIELD IL