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General NPI Number Information
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NPI Number | 1316130263
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Entity Type | Organization
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Legal Business Name | M HANSON INC
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 04/16/2009
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Provider Practice Location Address
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Address Line | 1615 W OLEANDER ST SUITE A
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City | FORT WORTH
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State | TX
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Zip | 76104-4025
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Country | US
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Telephone | 214-616-3355
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Fax | 817-632-5007
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Provider Business Mailing Address
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Address Line | 1615 W OLEANDER ST SUITE A
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City | FORT WORTH
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State | TX
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Zip | 76104-4025
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Country | US
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Telephone | 214-616-3355
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Fax | 817-632-5007
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK L HANSON
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Credential | D.C., L.AC
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Telephone | 214-616-3355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC00179
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4238
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License Number State | TX
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