Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 273531 | OR |
NPI | 1104007509 |
---|---|
Provider Name | Dr. William Jerrott Hanlan |
First Address | Medford, OR 97504-5576 |
Second Address | Ashland, OR 97520-1750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2007 |
Last Update Date | 07/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500729537 | (05) | OR |