Healthcare Provider Details

I. General information

NPI: 1174920201
Provider Name (Legal Business Name): HANSEN CHIROPRACTIC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 EVERGREEN WAY SUITE A
EVERETT WA
98203-3633
US

IV. Provider business mailing address

2000 N STATE ST
BELLINGHAM WA
98225-4218
US

V. Phone/Fax

Practice location:
  • Phone: 425-257-1000
  • Fax: 425-353-6787
Mailing address:
  • Phone: 360-671-1710
  • Fax: 360-671-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: EDDIE HANSEN
Title or Position: OWNER
Credential: DC
Phone: 360-671-1710