MEDICARE: DR. KENNETH BERYL HAHN 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	DC4899	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	650-360	OTHER	TX	UNITED HEALTH CARE NUMBER
2	603074	OTHER	TX	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1134278039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH BERYL HAHN D.C.

Provider Business Mailing Address
First Line	:	5757 RUFE SNOW DR
Second Line	:	SUITE B
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6080
Country	:	US
Telephone Number	:	817-577-3333
Fax Number	:

Provider Business Practice Location Address
First Line	:	5757 RUFE SNOW DR
Second Line	:	SUITE B
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6080
Country	:	US
Telephone Number	:	817-577-3333
Fax Number	:

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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