Provider Demographics
NPI:1629062484
Name:HANES, JEFFREY THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:THOMAS
Last Name:HANES
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 1:1 HEALTH DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8604
Mailing Address - Country:US
Mailing Address - Phone:740-772-5957
Mailing Address - Fax:740-772-6483
Practice Address - Street 1:6 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8603
Practice Address - Country:US
Practice Address - Phone:740-773-9355
Practice Address - Fax:740-772-6483
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2060693Medicaid
000000256388OtherANTHEM PIN NUMBER
000000256388OtherANTHEM PIN NUMBER
U71258Medicare UPIN