Provider Demographics
NPI:1972663730
Name:HANNA, SANDRA J (DC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:HANNA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27791 LA PAZ RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3919
Mailing Address - Country:US
Mailing Address - Phone:949-389-0400
Mailing Address - Fax:949-389-0401
Practice Address - Street 1:27901 LA PAZ RD
Practice Address - Street 2:SUITE I
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3932
Practice Address - Country:US
Practice Address - Phone:949-389-0400
Practice Address - Fax:949-389-0401
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0280810OtherBLUE SHIELD PROVIDER #
CADC28081OtherSTATE LICENSE
CAAC12596OtherSTATE LICENSE
CAAC12596OtherSTATE LICENSE
CADC0280810OtherBLUE SHIELD PROVIDER #