Healthcare Provider Details

I. General information

NPI: 1477589141
Provider Name (Legal Business Name): HANSON CHIROPRACTIC CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 NORTH MILL STREET
FERTILE MN
56540-0555
US

IV. Provider business mailing address

306 NORTH MILL STREET
FERTILE MN
56540-0555
US

V. Phone/Fax

Practice location:
  • Phone: 218-945-3220
  • Fax: 218-945-3220
Mailing address:
  • Phone: 218-945-3220
  • Fax: 218-945-3220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2832
License Number StateMN

VIII. Authorized Official

Name: DENNIS D HANSON
Title or Position: CHIROPRACTOR PRESIDENT
Credential: DC
Phone: 218-945-3220