MEDICARE: KIPLING G HANSEN DC LTD

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	B220	NV

General Provider Information

NPI Number	:	1902235740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIPLING G HANSEN DC LTD

Provider Business Mailing Address
First Line	:	6212 W CHARLESTON BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1130
Country	:	US
Telephone Number	:	702-877-6767
Fax Number	:	702-877-6434

Provider Business Practice Location Address
First Line	:	6212 W CHARLESTON BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1130
Country	:	US
Telephone Number	:	702-877-6767
Fax Number	:	702-877-6434

Authorized Official
Title or Position	:	PRESIDENT/DOCTOR OF CHIROPRACTIC
Name	:	KIPLING G HANSEN
Credential	:	DC
Telephone Number	:	702-877-6767

Provider Enumeration Date	:	11/02/2013
Last Update Date	:	11/02/2013

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