Healthcare Provider Details

I. General information

NPI: 1669547352
Provider Name (Legal Business Name): DR HILDA HATTAR DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E MAIN ST
GENOA IL
60135-1313
US

IV. Provider business mailing address

815 E MAIN ST
GENOA IL
60135-1313
US

V. Phone/Fax

Practice location:
  • Phone: 815-784-4346
  • Fax:
Mailing address:
  • Phone: 815-784-4346
  • Fax: 815-784-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number060-008843
License Number StateIL

VIII. Authorized Official

Name: DR. HILDA HATTAR
Title or Position: DIRECTOR
Credential: D.C.
Phone: 815-784-4346