Healthcare Provider Details

I. General information

NPI: 1720029242
Provider Name (Legal Business Name): ELIZABETH MARJORIE HANSEN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: ELIZABETH MARJORIE CONLON DC

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 W PENN AVE
WERNERSVILLE PA
19565-1413
US

IV. Provider business mailing address

1109 LILAC LN
WEST LAWN PA
19609-1127
US

V. Phone/Fax

Practice location:
  • Phone: 610-670-6333
  • Fax: 610-670-8730
Mailing address:
  • Phone: 610-670-6683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC009139
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: