Provider Demographics
NPI:1790719862
Name:HANNON, KRISTY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:LYNN
Last Name:HANNON
Suffix:
Gender:F
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:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM HEIGHTS
Mailing Address - State:MA
Mailing Address - Zip Code:02494
Mailing Address - Country:US
Mailing Address - Phone:781-559-8725
Mailing Address - Fax:781-559-8774
Practice Address - Street 1:365 WESTGATE DRIVE
Practice Address - Street 2:STE 3 & 4
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-583-2121
Practice Address - Fax:508-583-0086
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
650333OtherCIGNA IND
MAY36954OtherBCBS IND PPO
5116697OtherAETNA
65033OtherCIGNA GROUP
659628OtherACN UNITED HEALTH CARE
0034409OtherNEIGHBORHOOD HEALTH PLAN
MA1606611Medicaid
MA352595OtherHPHC
MAY36566OtherBCBS GROUP
MA1346436805OtherBMC
5116697OtherAETNA
650333OtherCIGNA IND