Provider Demographics
NPI:1043932064
Name:HANSEN, GARRETT WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:WILLIAM
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 1:2258 NASH ST N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1729
Mailing Address - Country:US
Mailing Address - Phone:252-674-7162
Mailing Address - Fax:252-674-7163
Practice Address - Street 1:2258 NASH ST N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1729
Practice Address - Country:US
Practice Address - Phone:252-674-7162
Practice Address - Fax:252-674-7163
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor