Provider Demographics
NPI:1053406074
Name:HANSSEN CHIROPRACTIC CLINIC, P.C.
Entity type:Organization
Organization Name:HANSSEN CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:CA
Authorized Official - Phone:308-382-7470
Mailing Address - Street 1:706 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-4529
Mailing Address - Country:US
Mailing Address - Phone:308-382-7470
Mailing Address - Fax:308-382-9398
Practice Address - Street 1:706 W 4TH ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-4529
Practice Address - Country:US
Practice Address - Phone:308-382-7470
Practice Address - Fax:308-382-9398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty