Provider Demographics
NPI:1023009073
Name:HANLEY, MICHAEL D (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:HANLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 494218
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-4218
Mailing Address - Country:US
Mailing Address - Phone:530-223-0790
Mailing Address - Fax:530-223-3378
Practice Address - Street 1:2021 VICTOR AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0410
Practice Address - Country:US
Practice Address - Phone:530-223-0790
Practice Address - Fax:530-223-3378
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0149320Medicare ID - Type Unspecified
CATO5556Medicare UPIN