Provider Demographics
NPI:1215956669
Name:HANLEY, STUART D (DC)
Entity type:Individual
Prefix:
First Name:STUART
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 1:2190 BANDIT TR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434
Mailing Address - Country:US
Mailing Address - Phone:937-776-1662
Mailing Address - Fax:
Practice Address - Street 1:955 FACTORY RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6136
Practice Address - Country:US
Practice Address - Phone:937-426-4545
Practice Address - Fax:937-426-4548
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2196350Medicaid
OHHA0876721Medicare ID - Type Unspecified
OHU65886Medicare UPIN