Healthcare Provider Details

I. General information

NPI: 1033229455
Provider Name (Legal Business Name): SUZANNE B. HANSON DC A CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 TAMALPAIS DR
CORTE MADERA CA
94925-1613
US

IV. Provider business mailing address

PO BOX 1848
NOVATO CA
94948-1848
US

V. Phone/Fax

Practice location:
  • Phone: 415-924-6500
  • Fax: 415-897-0346
Mailing address:
  • Phone: 415-897-9195
  • Fax: 415-897-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number900001537
License Number StateCA

VIII. Authorized Official

Name: MRS. SUZANNE B. HANSON
Title or Position: OWNER/PRACTITIONER
Credential: D.C.
Phone: 415-924-6500