Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2933 | OR |
N | 111NN1001X | Nutrition | 27-2933 | OR |
NPI | 1215098710 |
---|---|
Provider Name | Dr. Coby L. Hanes |
First Address | Prineville, OR 97754 |
Second Address | Prineville, OR 97754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 14/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7652 | (02) | OR |
U57652 | (02) | OR |