Provider Demographics
NPI:1669443099
Name:DIEHL HANLON CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:DIEHL HANLON CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANLON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-628-8800
Mailing Address - Street 1:700 MAIN ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1682
Mailing Address - Country:US
Mailing Address - Phone:641-628-8800
Mailing Address - Fax:641-628-8808
Practice Address - Street 1:700 MAIN ST
Practice Address - Street 2:SUITE 213
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1682
Practice Address - Country:US
Practice Address - Phone:641-628-8800
Practice Address - Fax:641-628-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0453969Medicaid
IA0453969Medicaid