Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 007240 | IA |
N | 111NR0400X | Rehabilitation Chiropractor | 007240 | IA |
NPI | 1073749990 |
---|---|
Provider Name | Dr. Mark Joseph Hanlon |
First Address | Pella, IA 50219-1682 |
Second Address | Pella, IA 50219-1682 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2009 |
Last Update Date | 05/02/2014 |