Provider Demographics
NPI:1508155052
Name:HERVEY, HANNIBAL (DC)
Entity Type:Individual
Prefix:DR
First Name:HANNIBAL
Middle Name:
Last Name:HERVEY
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 1:10981 COUNTRYWAY BLVD
Mailing Address - Street 2:APT 1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2630
Mailing Address - Country:US
Mailing Address - Phone:585-690-9289
Mailing Address - Fax:
Practice Address - Street 1:10981 COUNTRYWAY BLVD.
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626
Practice Address - Country:US
Practice Address - Phone:585-690-9289
Practice Address - Fax:585-690-9289
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor