Provider Demographics
NPI:1497817415
Name:HANSEN, DALE ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:ALLEN
Last Name:HANSEN
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 1:3321 AUBURN WAY SOUTH
Mailing Address - Street 2:SUITE G
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092
Mailing Address - Country:US
Mailing Address - Phone:253-927-3588
Mailing Address - Fax:
Practice Address - Street 1:3321 AUBURN WAY SOUTH
Practice Address - Street 2:SUITE G
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092
Practice Address - Country:US
Practice Address - Phone:253-833-3990
Practice Address - Fax:253-833-3993
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT90065Medicare UPIN