MEDICARE: DR. ROY HANSEN D.C.

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	111N00000X	Chiropractor	4156	OK

General Provider Information

NPI Number	:	1417351933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY HANSEN D.C.

Provider Business Mailing Address
First Line	:	12050 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-6807
Country	:	US
Telephone Number	:	405-242-3358
Fax Number	:

Provider Business Practice Location Address
First Line	:	12050 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-6807
Country	:	US
Telephone Number	:	405-242-3358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2014
Last Update Date	:	09/27/2022

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