Provider Demographics
NPI:1467517011
Name:HANSON, CHAD JEROME (MSPT ATC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:JEROME
Last Name:HANSON
Suffix:
Gender:M
Credentials:MSPT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1210
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-6210
Mailing Address - Country:US
Mailing Address - Phone:605-882-7000
Mailing Address - Fax:605-882-7819
Practice Address - Street 1:401 9TH AVE NW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1548
Practice Address - Country:US
Practice Address - Phone:605-882-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD00462255A2300X
SD1039225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN93659HAOtherWELLMARK BCBS OF MN
F246683OtherMIDLANDS CHOICE
6405469OtherUNITED HEALTH CARE MEDICA
2438329OtherAMERICAS PPO
SD4995112OtherWELLMARK BCBS OF SD
SD1039OtherDAKOTA CARE
103978OtherHEALTH PARTNERS
SD20522OtherSIOUX VALLEY HEALTH PLAN
SD5834710Medicaid
103978OtherHEALTH PARTNERS