Provider Demographics
NPI:1780324640
Name:VICTORIA, HANNA (DC)
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:VICTORIA
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 1:2467 MOSAIC WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701
Mailing Address - Country:US
Mailing Address - Phone:469-460-1332
Mailing Address - Fax:903-729-0316
Practice Address - Street 1:2467 MOSAIC WAY
Practice Address - Street 2:SUITE B
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:469-460-1332
Practice Address - Fax:903-729-0316
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163434111N00000X
TX15081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor