MEDICARE: GARY ALAN HANNAHS 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	CH60021341	WA

General Provider Information

NPI Number	:	1861652059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY ALAN HANNAHS D.C.

Provider Business Mailing Address
First Line	:	8221 NE HAZEL DELL AVE
Second Line	:	SUITE 104
City	:	VANCOUVER
State	:	WA
Zip	:	98665-8153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8221 NE HAZEL DELL AVE
Second Line	:	SUITE 104
City	:	VANCOUVER
State	:	WA
Zip	:	98665-8153
Country	:	US
Telephone Number	:	360-573-0729
Fax Number	:	360-573-0797

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

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	06/11/2008

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