Healthcare Provider Details

I. General information

NPI: 1982914859
Provider Name (Legal Business Name): MARK EDWARD HANNAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 GLEN RIDGE RD
RED HOOK NY
12571-1868
US

IV. Provider business mailing address

58 GLEN RIDGE RD
RED HOOK NY
12571-1868
US

V. Phone/Fax

Practice location:
  • Phone: 845-698-0432
  • Fax:
Mailing address:
  • Phone: 845-698-0432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number004841
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: