Provider Demographics
NPI:1982683223
Name:HANNAN, FORREST EUGENE (DC)
Entity Type:Individual
Prefix:
First Name:FORREST
Middle Name:EUGENE
Last Name:HANNAN
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 1:2028 E ROUTE 66
Mailing Address - Street 2:202
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4609
Mailing Address - Country:US
Mailing Address - Phone:626-914-1805
Mailing Address - Fax:
Practice Address - Street 1:2028 E ROUTE 66
Practice Address - Street 2:202
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4609
Practice Address - Country:US
Practice Address - Phone:626-914-1805
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23268Medicare ID - Type Unspecified