Provider Demographics
NPI:1285844746
Name:HANNAN, MARK DOUGLAS (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DOUGLAS
Last Name:HANNAN
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 1:306 ROUTE 87 HWY
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-9559
Mailing Address - Country:US
Mailing Address - Phone:570-433-9991
Mailing Address - Fax:570-433-9910
Practice Address - Street 1:306 ROUTE 87 HWY
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-9559
Practice Address - Country:US
Practice Address - Phone:570-433-9991
Practice Address - Fax:570-433-9910
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005428L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU42974Medicare UPIN
PA00045685Medicare ID - Type Unspecified