Provider Demographics
NPI:1265594568
Name:HANSON, MARK BRADLEY (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:BRADLEY
Last Name:HANSON
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 1:215 OHIO AVENUE
Mailing Address - Street 2:
Mailing Address - City:IOWA FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50126
Mailing Address - Country:US
Mailing Address - Phone:641-648-2255
Mailing Address - Fax:641-648-5600
Practice Address - Street 1:215 OHIO AVENUE
Practice Address - Street 2:
Practice Address - City:IOWA FALLS
Practice Address - State:IA
Practice Address - Zip Code:50126
Practice Address - Country:US
Practice Address - Phone:641-648-2255
Practice Address - Fax:641-648-5600
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0078634Medicaid
IA05992OtherBCBS
IA05992OtherBCBS
IA05992Medicare ID - Type Unspecified