Healthcare Provider Details

I. General information

NPI: 1992771984
Provider Name (Legal Business Name): HEIDI HANSEN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 W LAWRENCE AVE
CHARLOTTE MI
48813-1326
US

IV. Provider business mailing address

710 W LAWRENCE AVE
CHARLOTTE MI
48813-1326
US

V. Phone/Fax

Practice location:
  • Phone: 517-543-6360
  • Fax: 517-543-7773
Mailing address:
  • Phone: 517-543-6360
  • Fax: 517-543-7773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009156
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: