Provider Demographics
NPI:1518058312
Name:HANNER PHYSICAL REHABILITATION AND WELLNESS CENTER
Entity Type:Organization
Organization Name:HANNER PHYSICAL REHABILITATION AND WELLNESS CENTER
Other - Org Name:HANNER CHIROPRACTIC WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HANNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-225-8431
Mailing Address - Street 1:1517 N FANT ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4707
Mailing Address - Country:US
Mailing Address - Phone:864-225-8431
Mailing Address - Fax:864-225-9756
Practice Address - Street 1:10 FINANCIAL BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-225-8431
Practice Address - Fax:864-225-9756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH426Medicaid
SCU606720281Medicare UPIN