Provider Demographics
NPI:1881922474
Name:HANNAH, KAREN MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARIE
Last Name:HANNAH
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 1:1101 W JACKSON ST
Mailing Address - Street 2:STE A
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1559
Mailing Address - Country:US
Mailing Address - Phone:309-321-8412
Mailing Address - Fax:309-321-8340
Practice Address - Street 1:1101 W JACKSON ST
Practice Address - Street 2:STE A
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1559
Practice Address - Country:US
Practice Address - Phone:309-321-8412
Practice Address - Fax:309-321-8340
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL4659OtherMEDICARE PTAN
12024731OtherCAQH
751560001Medicare PIN