Healthcare Provider Details

I. General information

NPI: 1689988495
Provider Name (Legal Business Name): CODY HANSEN CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 SCHOFIELD AVE
WESTON WI
54476-2365
US

IV. Provider business mailing address

2114 SCHOFIELD AVE
WESTON WI
54476-2365
US

V. Phone/Fax

Practice location:
  • Phone: 715-355-4224
  • Fax: 715-355-4120
Mailing address:
  • Phone: 715-355-4224
  • Fax: 715-355-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number3727
License Number StateWI

VIII. Authorized Official

Name: CODY J HANSEN
Title or Position: OWNER
Credential: DC
Phone: 715-355-4224