Healthcare Provider Details

I. General information

NPI: 1194893610
Provider Name (Legal Business Name): DAVID CARDON HANSEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 EAST BASELINE RD. SUITE 112
PHOENIX AZ
85042
US

IV. Provider business mailing address

3220 EAST BASELINE RD. SUITE 112
PHOENIX AZ
85042
US

V. Phone/Fax

Practice location:
  • Phone: 480-228-0755
  • Fax:
Mailing address:
  • Phone: 480-228-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number7650
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: