Provider Demographics
NPI:1609848837
Name:HANNIGAN, MAUREEN T (DC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:T
Last Name:HANNIGAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 DUPONT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128
Mailing Address - Country:US
Mailing Address - Phone:215-483-6948
Mailing Address - Fax:215-483-3839
Practice Address - Street 1:601 DUPONT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2615
Practice Address - Country:US
Practice Address - Phone:215-483-6948
Practice Address - Fax:215-483-3839
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003526L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0071392000OtherKEYSTONE HEALTH PLAN EAST
PA071116664Medicaid
PA0467520OtherAETNA USHC
PA616812OtherCIGNA PPO
PA10928301OtherCAQH
PA42548OtherAWHN
PAJ16871OtherINTERCOUNTY
PA016871Medicare ID - Type Unspecified