Provider Demographics
NPI:1114199890
Name:HANNA CHIROPRACTIC PA
Entity Type:Organization
Organization Name:HANNA CHIROPRACTIC PA
Other - Org Name:VENICE CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN OWNER PRESID
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CHESTER
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-488-6308
Mailing Address - Street 1:617 SOUTH TAMIAMI TRAIL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3237
Mailing Address - Country:US
Mailing Address - Phone:941-488-6308
Mailing Address - Fax:941-480-1828
Practice Address - Street 1:617 SOUTH TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-3237
Practice Address - Country:US
Practice Address - Phone:941-488-6308
Practice Address - Fax:941-480-1828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5880111N00000X
IN08001215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty