Provider Demographics
NPI:1841379153
Name:HANNA, STEPHEN CHESTER (CHIROPRACTOR DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CHESTER
Last Name:HANNA
Suffix:
Gender:M
Credentials:CHIROPRACTOR DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 S TAMIAMI TRAIL
Mailing Address - Street 2:DBA VENICE CHIROPRACTIC CLINIC
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3237
Mailing Address - Country:US
Mailing Address - Phone:941-488-6308
Mailing Address - Fax:941-480-1828
Practice Address - Street 1:617 S TAMIAMI TRAIL
Practice Address - Street 2:VENICE CHIROPRACTIC CLINIC
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-3237
Practice Address - Country:US
Practice Address - Phone:941-488-6308
Practice Address - Fax:941-480-1828
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005880111N00000X
IN08001215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T87709Medicare UPIN
22308AMedicare ID - Type Unspecified