Provider Demographics
NPI:1487750469
Name:HANSON, ROSS K (DC)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:K
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 1:13481 60TH ST N STE 300
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-1089
Mailing Address - Country:US
Mailing Address - Phone:651-430-3229
Mailing Address - Fax:651-430-3265
Practice Address - Street 1:13481 60TH ST N STE 300
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-1089
Practice Address - Country:US
Practice Address - Phone:651-430-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN54M62HAOtherBCBS