Provider Demographics
NPI:1215775713
Name:HAN, JESSE (DC)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:HAN
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 1:225 VERBENA ST APT 4206
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-3356
Mailing Address - Country:US
Mailing Address - Phone:551-777-2550
Mailing Address - Fax:
Practice Address - Street 1:1661 CELANESE RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1728
Practice Address - Country:US
Practice Address - Phone:803-329-8266
Practice Address - Fax:803-369-7301
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDC.5100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor