Provider Demographics
NPI:1518068626
Name:HANSON, DUANE LARRY (DC)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:LARRY
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 1:1717 S BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5175
Mailing Address - Country:US
Mailing Address - Phone:405-341-4653
Mailing Address - Fax:405-341-8718
Practice Address - Street 1:1717 S BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5175
Practice Address - Country:US
Practice Address - Phone:405-341-4653
Practice Address - Fax:405-341-8718
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor