Charles Richard Hathaway, D.C

Primary specialty

Orthopedic ChiropractorTaxonomy code 111NX0800X

License

27-1248 Issued in OR

Practice address

10011 SE Division St
Suite 205
Portland, OR 97266-1351

Phone

(503) 256-2654

Fax

(503) 256-2493

NPI assigned

Oct 18, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chirocare Chiropractic Clinic, PC

  • Chiropractor
  • Portland, OR
  • NPI 1578847448
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699488000000",
    "number": "1093896631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10011 SE DIVISION ST",
            "address_2": "SUITE 209",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972661351",
            "telephone_number": "503-256-2654",
            "fax_number": "503-256-2493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10011 SE DIVISION ST",
            "address_2": "SUITE 205",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972661351",
            "telephone_number": "503-256-2654",
            "fax_number": "503-256-2493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATHAWAY",
        "first_name": "CHARLES",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "D.C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Orthopedic",
            "state": "OR",
            "license": "27-1248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "20-1718201",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Noelle Hatfield
• Mark Travis Hatfield, DPT
• Rachel Hathaway-Boschee, BCABA
• Anneke P Hathaway, PSYD
• Chalese Marie Hathaway, DC
• Jill L. Hathaway, LAC
• Mark Allen Hathaway
• Nicole Christine Hathaway, MA, CCC-SLP
• Norma Hathaway, RN
• Sharon M Hatrak

• Orthopedic Chiropractor in Portland, OR
• Providers in Portland, OR by specialty
• Orthopedic Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.