Provider Demographics
NPI:1679625974
Name:HANSEN CHIROPRACTIC, P.S.
Entity type:Organization
Organization Name:HANSEN CHIROPRACTIC, P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-671-1710
Mailing Address - Street 1:2000 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4218
Mailing Address - Country:US
Mailing Address - Phone:360-671-1710
Mailing Address - Fax:360-671-1605
Practice Address - Street 1:1943 MAIN ST.
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248
Practice Address - Country:US
Practice Address - Phone:360-384-1396
Practice Address - Fax:360-384-1365
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANSEN CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB19167OtherMEDICARE GROUP PIN