Provider Demographics
NPI:1134278039
Name:HAHN, KENNETH BERYL (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:BERYL
Last Name:HAHN
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 1:5757 RUFE SNOW DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6080
Mailing Address - Country:US
Mailing Address - Phone:817-577-3333
Mailing Address - Fax:
Practice Address - Street 1:5757 RUFE SNOW DR
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6080
Practice Address - Country:US
Practice Address - Phone:817-577-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650-360OtherUNITED HEALTH CARE NUMBER
TX603074OtherBCBS PROVIDER NUMBER