Individual
DR. CHARLES RICHARD HATHAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C
Contact information
Practice address
10011 SE DIVISION ST, SUITE 205, PORTLAND, OR 97266-1351
(503) 256-2654
(503) 256-2493
Mailing address
10011 SE DIVISION ST, SUITE 209, PORTLAND, OR 97266-1351
(503) 256-2654
(503) 256-2493
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
27-1248
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-1718201
TAX ID
OR
Enumeration date
10/18/2006
Last updated
11/09/2023
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