Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038010803 | IL |
N | 111NP0017X | Pediatric Chiropractor | 038010803 | IL |
N | 111NR0400X | Rehabilitation Chiropractor | 038010803 | IL |
N | 111NS0005X | Chiropractic Sports Physician | 038010803 | IL |
N | 225100000X | Physical Therapist | 038010803 | IL |
NPI | 1063572071 |
---|---|
Provider Name | Dr. Michael William Hanley |
First Address | Shorewood, IL 60404-8513 |
Second Address | Shorewood, IL 60404-8513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 20/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09932745 | BLUE CROSS/BLUE SHIELD (01) | IL |