Healthcare Provider Details

I. General information

NPI: 1265598627
Provider Name (Legal Business Name): LAURA ANNE HANSON DC, MS,DICCP, NDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 LONG ISLAND TER
ATLANTA GA
30342-2572
US

IV. Provider business mailing address

4930 LONG ISLAND TER
ATLANTA GA
30342-2572
US

V. Phone/Fax

Practice location:
  • Phone: 678-501-5172
  • Fax: 650-265-1762
Mailing address:
  • Phone: 678-501-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCHIR005530
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: