MEDICARE: HANSEN CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	7650	AZ

General Provider Information

NPI Number	:	1053628354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANSEN CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	3220 E BASELINE RD
Second Line	:	SUITE 112
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7115
Country	:	US
Telephone Number	:	602-437-2225
Fax Number	:	602-437-1309

Provider Business Practice Location Address
First Line	:	3220 E BASELINE RD
Second Line	:	SUITE 112
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7115
Country	:	US
Telephone Number	:	602-437-2225
Fax Number	:	602-437-1309

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID C HANSEN
Credential	:	DC
Telephone Number	:	602-437-2225

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	09/08/2010

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