MEDICARE: KEVIN DEAN HATFIELD D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	6804	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	469849	OTHER	MO	HEALTHLINK ID #
2	142992	OTHER	MO	BLUE CROSS/ BL SHILD ID #
3	664453	OTHER	MO	ACN & UNITED HEALTHCARE

General Provider Information

NPI Number	:	1316048309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN DEAN HATFIELD D.C.

Provider Business Mailing Address
First Line	:	3213 S CAMPBELL AVE STE E
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-4912
Country	:	US
Telephone Number	:	417-886-9355
Fax Number	:	417-886-9366

Provider Business Practice Location Address
First Line	:	3213 S CAMPBELL AVE STE E
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-4912
Country	:	US
Telephone Number	:	417-886-9355
Fax Number	:	417-886-9366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/09/2007

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