Provider Demographics
NPI:1174691844
Name:HATHAWAY, WILLIAM LEE (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEE
Last Name:HATHAWAY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44530 SAN PABLO AVE
Mailing Address - Street 2:204
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3596
Mailing Address - Country:US
Mailing Address - Phone:760-340-1264
Mailing Address - Fax:760-340-0982
Practice Address - Street 1:44530 SAN PABLO AVE
Practice Address - Street 2:204
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3596
Practice Address - Country:US
Practice Address - Phone:760-340-1264
Practice Address - Fax:760-340-0982
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0135440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0135440Medicare ID - Type Unspecified