Healthcare Provider Details

I. General information

NPI: 1396911095
Provider Name (Legal Business Name): MICHAEL W HANLEY DC CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 BROOK FOREST AVE UNIT P
SHOREWOOD IL
60404-8513
US

IV. Provider business mailing address

850 BROOK FOREST AVE UNIT P
SHOREWOOD IL
60404-8513
US

V. Phone/Fax

Practice location:
  • Phone: 815-436-1988
  • Fax: 815-436-2278
Mailing address:
  • Phone: 815-436-1988
  • Fax: 815-436-2278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number038010803
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038010803
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number038010803
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number038010803
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038010803
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL WILLIAM HANLEY
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 815-436-1988