Provider Demographics
NPI:1598220089
Name:HANNA, LOREN STAN IV (DC)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:STAN
Last Name:HANNA
Suffix:IV
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 1:15 SW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4371
Mailing Address - Country:US
Mailing Address - Phone:360-666-7722
Mailing Address - Fax:360-666-3388
Practice Address - Street 1:408 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6308
Practice Address - Country:US
Practice Address - Phone:541-757-9933
Practice Address - Fax:541-757-7713
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60822881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor