MEDICARE: MERLIN GRACE HANNES D.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC29282	CA

General Provider Information

NPI Number	:	1124247796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERLIN GRACE HANNES D.C

Provider Business Mailing Address
First Line	:	145 HURLBUT ST APT 306
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3131
Country	:	US
Telephone Number	:	213-422-7052
Fax Number	:

Provider Business Practice Location Address
First Line	:	3407 W 6TH ST STE 604
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-2553
Country	:	US
Telephone Number	:	213-422-7052
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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