Provider Demographics
NPI:1205816568
Name:HANSSEN, MARK LOUIS (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:LOUIS
Last Name:HANSSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:LOUIS
Other - Last Name:HANSSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:18900 SWALLOW HILL PT
Mailing Address - Street 2:
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-7247
Mailing Address - Country:US
Mailing Address - Phone:402-296-2390
Mailing Address - Fax:402-593-0310
Practice Address - Street 1:1225 PAPILLION DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-5708
Practice Address - Country:US
Practice Address - Phone:402-593-9930
Practice Address - Fax:402-593-0310
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE918111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE440042OtherUNITED HEALTH CARE
NE350029171OtherRAILROAD MEDICARE
NE1973222OtherACS IOWA MEDICAID
NE9716OtherBCBS
NE350029171OtherRAILROAD MEDICARE
NE1973222OtherACS IOWA MEDICAID