MEDICARE: HATFIELD CHIROPRACTIC CLINIC INC

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	1319	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000134014	OTHER		ANTHEM BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	279564334-00	OTHER	OH	BUREAU WRKRS COMPENSATION

General Provider Information

NPI Number	:	1912906728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HATFIELD CHIROPRACTIC CLINIC INC

Provider Business Mailing Address
First Line	:	130 N MAIN ST
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-1106
Country	:	US
Telephone Number	:	937-644-4310
Fax Number	:	937-644-3228

Provider Business Practice Location Address
First Line	:	130 N MAIN ST
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-1106
Country	:	US
Telephone Number	:	937-644-4310
Fax Number	:	937-644-3228

Authorized Official
Title or Position	:	DR/OWNER
Name	:	DR. JEFFERY CHARLES HATFIELD
Credential	:	DC
Telephone Number	:	937-644-4310

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	03/20/2024

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