Provider Demographics
NPI:1396911095
Name:MICHAEL W HANLEY DC CO
Entity type:Organization
Organization Name:MICHAEL W HANLEY DC CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-436-1988
Mailing Address - Street 1:850 BROOK FOREST AVE
Mailing Address - Street 2:UNIT P
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-8513
Mailing Address - Country:US
Mailing Address - Phone:815-436-1988
Mailing Address - Fax:815-436-2278
Practice Address - Street 1:850 BROOK FOREST AVE
Practice Address - Street 2:UNIT P
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-8513
Practice Address - Country:US
Practice Address - Phone:815-436-1988
Practice Address - Fax:815-436-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010803111NS0005X, 111NR0400X, 111NP0017X, 225100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932745OtherBLUE CROSS/BLUE SHIELD
IL09932745OtherBLUE CROSS/BLUE SHIELD