MEDICARE: DR. WAYNE THOMAS 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	5319703-1202	UT

General Provider Information

NPI Number	:	1851608640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE THOMAS HANSEN D.C.

Provider Business Mailing Address
First Line	:	1844 FORT UNION BLVD
Second Line	:	#10
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3090
Country	:	US
Telephone Number	:	801-946-4220
Fax Number	:

Provider Business Practice Location Address
First Line	:	1844 FORT UNION BLVD
Second Line	:	#10
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3090
Country	:	US
Telephone Number	:	801-946-4220
Fax Number	:

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

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	09/01/2010

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