Provider Demographics
NPI:1104007509
Name:HANLAN, WILLIAM JERROTT (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JERROTT
Last Name:HANLAN
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 S MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-3354
Mailing Address - Country:US
Mailing Address - Phone:530-340-2399
Mailing Address - Fax:530-331-0038
Practice Address - Street 1:700 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3354
Practice Address - Country:US
Practice Address - Phone:530-340-2399
Practice Address - Fax:530-331-0038
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273531111NR0400X
CA29668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500729537Medicaid