Provider Demographics
NPI:1346247921
Name:HANSON, THOMAS JACK (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JACK
Last Name:HANSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-2976
Mailing Address - Country:US
Mailing Address - Phone:218-751-9533
Mailing Address - Fax:218-444-4759
Practice Address - Street 1:702 5TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-2976
Practice Address - Country:US
Practice Address - Phone:218-751-9533
Practice Address - Fax:218-444-4759
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1N075HAOtherBCBC MN
MN230313OtherACN GROUP
T65593Medicare UPIN