Healthcare Provider Details

I. General information

NPI: 1902235740
Provider Name (Legal Business Name): KIPLING G HANSEN DC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6212 W CHARLESTON BLVD STE 100
LAS VEGAS NV
89146-1130
US

IV. Provider business mailing address

6212 W CHARLESTON BLVD STE 100
LAS VEGAS NV
89146-1130
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-6767
  • Fax: 702-877-6434
Mailing address:
  • Phone: 702-877-6767
  • Fax: 702-877-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB220
License Number StateNV

VIII. Authorized Official

Name: KIPLING G HANSEN
Title or Position: PRESIDENT/DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 702-877-6767