Provider Demographics
NPI:1619411170
Name:HANBA CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:HANBA CHIROPRACTIC PLLC
Other - Org Name:REVOLUTION CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HANBA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-900-8952
Mailing Address - Street 1:2315 LYNN RD
Mailing Address - Street 2:STE 103
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-6743
Mailing Address - Country:US
Mailing Address - Phone:919-900-8952
Mailing Address - Fax:
Practice Address - Street 1:2315 LYNN RD
Practice Address - Street 2:STE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-6743
Practice Address - Country:US
Practice Address - Phone:919-900-8952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty