Provider Demographics
NPI:1306018429
Name:HANSEN CHIROPRACTIC AND NEUROLOGY HEALTH CENTER P C
Entity Type:Organization
Organization Name:HANSEN CHIROPRACTIC AND NEUROLOGY HEALTH CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST RECORDS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-878-2273
Mailing Address - Street 1:1210 OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-1840
Mailing Address - Country:US
Mailing Address - Phone:208-878-2273
Mailing Address - Fax:208-878-2275
Practice Address - Street 1:1210 OAKLEY AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-1840
Practice Address - Country:US
Practice Address - Phone:208-878-2273
Practice Address - Fax:208-878-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC1450OtherBLUE CROSS
IDC1450OtherBLUE CROSS
ID1674191Medicare PIN