Healthcare Provider Details

I. General information

NPI: 1164298626
Provider Name (Legal Business Name): MINA HANNA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10635 PONTOFINO CIR
TRINITY FL
34655-7061
US

IV. Provider business mailing address

10635 PONTOFINO CIR
TRINITY FL
34655-7061
US

V. Phone/Fax

Practice location:
  • Phone: 727-333-5318
  • Fax:
Mailing address:
  • Phone: 727-333-5318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH14274
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: