=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205224748
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RYAN BROCK HATCHER DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2015
-----------------------------------------------------
Last Update Date | 09/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 W BURLINGTON AVE STE 100
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52601-1914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-208-9456
-----------------------------------------------------
Fax | 319-208-9456
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 603 S 4TH ST
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52601-5806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-542-2596
-----------------------------------------------------
Fax | 319-208-9456
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 076576
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------