Provider Demographics
NPI:1437394152
Name:HANSON, JASON LEVI (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:LEVI
Last Name:HANSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 15TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2764
Mailing Address - Country:US
Mailing Address - Phone:720-494-1525
Mailing Address - Fax:
Practice Address - Street 1:630 15TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2764
Practice Address - Country:US
Practice Address - Phone:720-494-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor