Provider Demographics
NPI:1114051364
Name:ROBERT G. HANSON, D.C., P.A.
Entity Type:Organization
Organization Name:ROBERT G. HANSON, D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-596-1051
Mailing Address - Street 1:3832 WINDING FOREST DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-6683
Mailing Address - Country:US
Mailing Address - Phone:972-822-7084
Mailing Address - Fax:
Practice Address - Street 1:3401 W AIRPORT FWY
Practice Address - Street 2:SUITE 101
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5924
Practice Address - Country:US
Practice Address - Phone:214-596-1051
Practice Address - Fax:214-596-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9665111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00206XMedicare ID - Type Unspecified