Individual provider Active NPI

Dwayne Robert Hannam, D.C.

  • Chiropractor
  • Middleboro, MA
National Provider Identifier
1275674145
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2483 Issued in MA
Practice address
205 W Grove St
Suite D
Middleboro, MA 02346-1462
Phone
(508) 947-6455
NPI assigned
Feb 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2483 MA Primary

Addresses

Primary practice location

205 W Grove St
Suite D
Middleboro, MA 02346-1462

Mailing address

205 W Grove St
Suite D
Middleboro, MA 02346-1462
Phone (508) 947-6455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040216000396 MA Practitioner - Chiropractic 2860387396 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - West Sunnyvale, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

205 W Grove St
Suite D
Middleboro, MA 02346-1462
Phone (508) 947-6455

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Cranberry Chiropractic Chiropractor CurrentSince Apr 6, 2000 Accepting new patients

Locations

205 W Grove St
Ste D
Middleboro, MA 02346
Phone (508) 946-6455

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275674145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 W GROVE ST",
            "address_2": "SUITE D",
            "city": "MIDDLEBORO",
            "state": "MA",
            "postal_code": "023461462",
            "telephone_number": "508-947-6455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 W GROVE ST",
            "address_2": "SUITE D",
            "city": "MIDDLEBORO",
            "state": "MA",
            "postal_code": "023461462",
            "telephone_number": "508-947-6455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNAM",
        "first_name": "DWAYNE",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MA",
            "license": "2483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middleboro, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.