Provider Demographics
NPI:1760515795
Name:HANNIGAN, ROBERT JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:HANNIGAN
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 1:11 MARSHALL ROAD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4117
Mailing Address - Country:US
Mailing Address - Phone:845-297-6688
Mailing Address - Fax:845-298-7401
Practice Address - Street 1:11 MARSHALL ROAD
Practice Address - Street 2:SUITE 2A
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4117
Practice Address - Country:US
Practice Address - Phone:845-297-6688
Practice Address - Fax:845-298-7401
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3660111N00000X
MA751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100331OtherPOMCO
NY0060116OtherGHI
NY0060116OtherGHI