Provider Demographics
NPI:1104219195
Name:DUPONT CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:DUPONT CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASA
Authorized Official - Middle Name:NELS
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-912-9653
Mailing Address - Street 1:1000 STATION DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8727
Mailing Address - Country:US
Mailing Address - Phone:253-912-9653
Mailing Address - Fax:253-912-9660
Practice Address - Street 1:1000 STATION DR STE 100
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-8727
Practice Address - Country:US
Practice Address - Phone:253-912-9653
Practice Address - Fax:253-912-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-14
Last Update Date:2015-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60127381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty