Provider Demographics
NPI:1023045945
Name:HANSON, DENNIS D (DC)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:D
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:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:FERTILE
Mailing Address - State:MN
Mailing Address - Zip Code:56540-0555
Mailing Address - Country:US
Mailing Address - Phone:218-945-3220
Mailing Address - Fax:218-945-3220
Practice Address - Street 1:306 NORTH MILL STREET
Practice Address - Street 2:
Practice Address - City:FERTILE
Practice Address - State:MN
Practice Address - Zip Code:56540-0555
Practice Address - Country:US
Practice Address - Phone:218-945-3220
Practice Address - Fax:218-945-3220
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN665228000Medicaid
ND19806OtherBCND
MN1H004HAOtherBCBS
U11337Medicare UPIN
C04177Medicare ID - Type Unspecified