Provider Demographics
NPI:1235377680
Name:HANSEN, BRANT DAIN (D,C,)
Entity Type:Individual
Prefix:DR
First Name:BRANT
Middle Name:DAIN
Last Name:HANSEN
Suffix:
Gender:M
Credentials:D,C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 TOPAZ DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-1545
Mailing Address - Country:US
Mailing Address - Phone:415-810-6150
Mailing Address - Fax:
Practice Address - Street 1:885 OLIVE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-2420
Practice Address - Country:US
Practice Address - Phone:415-892-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor