Provider Demographics
NPI:1619243896
Name:PRO-HEALTH CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:PRO-HEALTH CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-866-4145
Mailing Address - Street 1:1031 N CULLEN ST
Mailing Address - Street 2:PO BOX 262
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-2007
Mailing Address - Country:US
Mailing Address - Phone:219-866-4145
Mailing Address - Fax:
Practice Address - Street 1:1031 N CULLEN ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-2007
Practice Address - Country:US
Practice Address - Phone:219-866-4145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-01
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002594A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty