Provider Demographics
NPI:1477821163
Name:HANSEN CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:HANSEN CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-362-8892
Mailing Address - Street 1:3962 CENTER ST NE STE D
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2943
Mailing Address - Country:US
Mailing Address - Phone:503-362-8892
Mailing Address - Fax:503-362-9593
Practice Address - Street 1:3962 CENTER ST NE STE D
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2943
Practice Address - Country:US
Practice Address - Phone:503-362-8892
Practice Address - Fax:503-362-9593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty