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General NPI Number Information
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NPI Number | 1538438577
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Entity Type | Individual
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Provider Name | RICHARD E HANSEN JR. D.C.
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Gender | Male
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 2100 18TH AVE SUITE 2 SS
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City | ROCK ISLAND
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State | IL
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Zip | 61201-3668
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Country | US
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Telephone | 309-793-6688
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 18TH AVE SUITE 2 SS
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City | ROCK ISLAND
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State | IL
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Zip | 61201-3668
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Country | US
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Telephone | 309-793-6688
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 038.004795
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License Number State | IL
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