Provider Demographics
NPI:1043364177
Name:BOYSEN, HANS SOO III (DC)
Entity Type:Individual
Prefix:DR
First Name:HANS
Middle Name:SOO
Last Name:BOYSEN
Suffix:III
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 1:13142 KNOTTY PINE ST
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2164
Mailing Address - Country:US
Mailing Address - Phone:805-990-2419
Mailing Address - Fax:
Practice Address - Street 1:20181 SATICOY ST
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-2506
Practice Address - Country:US
Practice Address - Phone:818-709-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor