=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487914230
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANSEN CHIROPRACTIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2012
-----------------------------------------------------
Last Update Date | 05/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 833 N PARK RD SUITE 107
-----------------------------------------------------
City | WYOMISSING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19610-1341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-750-5441
-----------------------------------------------------
Fax | 610-750-5482
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 833 N PARK RD SUITE 107
-----------------------------------------------------
City | WYOMISSING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19610-1341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-750-5441
-----------------------------------------------------
Fax | 610-750-5482
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | DR. ELIZABETH M HANSEN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 610-750-5441
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC009139
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------