Provider Demographics
NPI:1700128220
Name:HAN, JOHN S (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:HAN
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 1:8737 S TACOMA WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4544
Mailing Address - Country:US
Mailing Address - Phone:253-581-2296
Mailing Address - Fax:253-581-7565
Practice Address - Street 1:8737 S TACOMA WAY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4544
Practice Address - Country:US
Practice Address - Phone:253-581-2296
Practice Address - Fax:253-581-7565
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U67705Medicare UPIN