Provider Demographics
NPI:1811088990
Name:HANNER, DOUGLAS WILLIAM (DC)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:WILLIAM
Last Name:HANNER
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 1:10 FINANCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1770
Mailing Address - Country:US
Mailing Address - Phone:855-663-7772
Mailing Address - Fax:864-309-8004
Practice Address - Street 1:10 FINANCIAL BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1770
Practice Address - Country:US
Practice Address - Phone:855-663-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1991Medicaid
SCU606720281Medicare PIN