Provider Demographics
NPI:1770662959
Name:HANEY, PERRY LYNN (MD, DC)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:LYNN
Last Name:HANEY
Suffix:
Gender:M
Credentials:MD, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8500 PARK MEADOWS DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2700
Mailing Address - Country:US
Mailing Address - Phone:303-367-2225
Mailing Address - Fax:303-951-7492
Practice Address - Street 1:8500 PARK MEADOWS DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2700
Practice Address - Country:US
Practice Address - Phone:303-367-2225
Practice Address - Fax:303-951-7492
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODC13789111N00000X
CO32744207XS0117X, 2081P2900X, 2081S0010X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No111N00000XChiropractic ProvidersChiropractor
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804192Medicare ID - Type UnspecifiedMCR INDIVIDUAL