MEDICARE: JACOB HANSON DC INC

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	261Q00000X	Clinic/Center	7655	AZ

General Provider Information

NPI Number	:	1427357581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACOB HANSON DC INC

Provider Business Mailing Address
First Line	:	1746 E SOUTH MOUNTAIN AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-8074
Country	:	US
Telephone Number	:	701-306-3579
Fax Number	:	602-840-4056

Provider Business Practice Location Address
First Line	:	2824 E INDIAN SCHOOL RD
Second Line	:	SUITE 5
City	:	PHOENIX
State	:	AZ
Zip	:	85016-6863
Country	:	US
Telephone Number	:	602-840-0056
Fax Number	:	602-840-4056

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JACOB D HANSON
Credential	:	DC
Telephone Number	:	602-840-0056

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	03/15/2011

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