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NPI Code Detail

MEDICARE: DR. JACOB DANIEL HANSON DC

MEDICARE: DR. JACOB DANIEL HANSON DC
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
1111N00000XChiropractor7655AZ

General Provider Information

NPI Number : 1477687432
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACOB DANIEL HANSON DC
Provider Business Mailing Address
First Line : 2824 E INDIAN SCHOOL RD
Second Line : #5
City : PHOENIX
State : AZ
Zip : 85016-6863
Country : US
Telephone Number : 602-840-0056
Fax Number : 602-840-4056
Provider Business Practice Location Address
First Line : 2836 E INDIAN SCHOOL RD STE A8
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-6864
Country : US
Telephone Number : 602-840-0056
Fax Number : 602-840-4056
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 08/19/2021

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