Provider Demographics
NPI:1770648602
Name:HANIFEN, MICHAEL JON (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JON
Last Name:HANIFEN
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111224
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-1224
Mailing Address - Country:US
Mailing Address - Phone:907-337-7463
Mailing Address - Fax:907-337-7400
Practice Address - Street 1:1120 HUFFMAN RD STE 23
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3561
Practice Address - Country:US
Practice Address - Phone:907-337-7463
Practice Address - Fax:907-337-7400
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK153160Medicare ID - Type Unspecified