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General NPI Number Information
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NPI Number | 1477821163
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Entity Type | Organization
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Legal Business Name | HANSEN CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 3962 CENTER ST NE STE D
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City | SALEM
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State | OR
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Zip | 97301-2943
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Country | US
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Telephone | 503-362-8892
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Fax | 503-362-9593
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Provider Business Mailing Address
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Address Line | 3962 CENTER ST NE STE D
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City | SALEM
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State | OR
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Zip | 97301-2943
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Country | US
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Telephone | 503-362-8892
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Fax | 503-362-9593
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Authorized Official
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Title or Position | OWNER
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Name | DR. TERRENCE MARTIN HANSEN
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Credential | D.C.
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Telephone | 503-362-8892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1994
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License Number State | OR
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