Provider Demographics
NPI:1811053135
Name:HATFIELD, BRIAN LEE (DC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:LEE
Last Name:HATFIELD
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 1:11630 CHAYOTE STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3340
Mailing Address - Country:US
Mailing Address - Phone:310-440-4098
Mailing Address - Fax:
Practice Address - Street 1:11630 CHAYOTE STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3340
Practice Address - Country:US
Practice Address - Phone:310-440-4098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor