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General NPI Number Information
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NPI Number | 1770803611
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Entity Type | Organization
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Legal Business Name | MARANATHA SPRINGS INC
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 06/02/2010
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Provider Practice Location Address
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Address Line | 2866 WHIPPLE AVE NW
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City | CANTON
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State | OH
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Zip | 44708
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Country | US
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Telephone | 330-478-2186
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Fax | 330-478-2330
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Provider Business Mailing Address
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Address Line | 2866 WHIPPLE AVE NW
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City | CANTON
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State | OH
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Zip | 44708
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Country | US
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Telephone | 330-478-2186
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Fax | 330-478-2330
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Authorized Official
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Title or Position | MD / PRESIDENT
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Name | DR. MARK W HATCHER
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Credential | MD
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Telephone | 330-478-2186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | OH062098
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | OH062098
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License Number State | OH
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