Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC10991 | CA |
NPI | 1457362675 |
---|---|
Provider Name | Dr. Jerome Mason Hanning |
First Address | Long Beach, CA 90803-5013 |
Second Address | Long Beach, CA 90803-5013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |