Provider Demographics
NPI:1508866617
Name:HANSEN, NICOLAI LORENSON (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLAI
Middle Name:LORENSON
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 1:5622 SOUTHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-1211
Mailing Address - Country:US
Mailing Address - Phone:502-368-8568
Mailing Address - Fax:
Practice Address - Street 1:7439 3RD STREET RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-4366
Practice Address - Country:US
Practice Address - Phone:502-618-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4278111N00000X
NJMC04424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
O65562Medicare UPIN
KY1807901Medicare ID - Type Unspecified