Provider Demographics
NPI:1174525968
Name:HANSEN, DAVID J (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:HANSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:205 E. CENTER
Mailing Address - City:LE ROY
Mailing Address - State:IL
Mailing Address - Zip Code:61752-0117
Mailing Address - Country:US
Mailing Address - Phone:309-962-4476
Mailing Address - Fax:
Practice Address - Street 1:205 E CENTER ST
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:IL
Practice Address - Zip Code:61752-1719
Practice Address - Country:US
Practice Address - Phone:309-962-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL905370Medicare UPIN
IL905370Medicare Oscar/Certification
IL905370Medicare PIN