Provider Demographics
NPI:1073749990
Name:HANLON, MARK JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
Last Name:HANLON
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 1:700 MAIN ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1682
Mailing Address - Country:US
Mailing Address - Phone:724-322-2045
Mailing Address - Fax:641-628-8808
Practice Address - Street 1:700 MAIN ST
Practice Address - Street 2:SUITE 213
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1682
Practice Address - Country:US
Practice Address - Phone:641-628-8800
Practice Address - Fax:641-628-8808
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007240111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1580001Medicare PIN