MEDICARE: DR. DEREK LEVI HANSEN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	16657	TX

General Provider Information

NPI Number	:	1093687501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEREK LEVI HANSEN DC

Provider Business Mailing Address
First Line	:	4519 MILLS PARK CIR STE 300
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-1109
Country	:	US
Telephone Number	:	979-383-2105
Fax Number	:

Provider Business Practice Location Address
First Line	:	4519 MILLS PARK CIR STE 300
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-1109
Country	:	US
Telephone Number	:	979-383-2105
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2025
Last Update Date	:	09/23/2025

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