Provider Demographics
NPI:1134203318
Name:HENNAN, CAROLE ANN (DC)
Entity type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:ANN
Last Name:HENNAN
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 1:1406 MCDONALD DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-6316
Mailing Address - Country:US
Mailing Address - Phone:281-332-2225
Mailing Address - Fax:
Practice Address - Street 1:903 BAY AREA BLVD
Practice Address - Street 2:STE C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058
Practice Address - Country:US
Practice Address - Phone:281-332-2225
Practice Address - Fax:281-286-3299
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T13789Medicare UPIN
601114Medicare ID - Type Unspecified