Healthcare Provider Details

I. General information

NPI: 1083079842
Provider Name (Legal Business Name): HANAH JO HLAVAC D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W GREGORY BLVD SUITE 315
KANSAS CITY MO
64114-1107
US

IV. Provider business mailing address

222 W GREGORY BLVD SUITE 315
KANSAS CITY MO
64114-1107
US

V. Phone/Fax

Practice location:
  • Phone: 816-361-0655
  • Fax:
Mailing address:
  • Phone: 816-361-0655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2015032927
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: