MEDICARE: DIANA HASSAN DC

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	038.013560	IL

General Provider Information

NPI Number	:	1316563158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA HASSAN DC

Provider Business Mailing Address
First Line	:	570 VILLAGE CENTER DR STE 205
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-4526
Country	:	US
Telephone Number	:	630-920-4670
Fax Number	:

Provider Business Practice Location Address
First Line	:	1255 S STATE ST UNIT 6
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-1928
Country	:	US
Telephone Number	:	312-248-3618
Fax Number	:

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

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	06/17/2020

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Directions to “ DIANA HASSAN DC” Practice Location

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