Healthcare Provider Details

I. General information

NPI: 1790779171
Provider Name (Legal Business Name): DAVID J. HANSEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 28 1/4 RD SUITE 1
GRAND JUNCTION CO
81501-4961
US

IV. Provider business mailing address

514 28 1/4 RD SUITE 1
GRAND JUNCTION CO
81501-4961
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-8162
  • Fax: 970-245-4308
Mailing address:
  • Phone: 970-242-8162
  • Fax: 970-245-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4056
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number757CHI-INACTIVE
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: