Provider Demographics
NPI:1518263490
Name:HANNAH, JERALD R (DC)
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:R
Last Name:HANNAH
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 1:1391 WOODSIDE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3578
Mailing Address - Country:US
Mailing Address - Phone:650-365-7775
Mailing Address - Fax:
Practice Address - Street 1:1391 WOODSIDE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3578
Practice Address - Country:US
Practice Address - Phone:650-365-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor