Provider Demographics
NPI:1518081603
Name:HANSON, ROBERT GREG (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GREG
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 1:3832 WINDING FOREST DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-6683
Mailing Address - Country:US
Mailing Address - Phone:972-822-7084
Mailing Address - Fax:
Practice Address - Street 1:3401 W AIRPORT FWY
Practice Address - Street 2:SUITE 101
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5924
Practice Address - Country:US
Practice Address - Phone:214-596-1051
Practice Address - Fax:214-596-1052
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9665111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C1867Medicare ID - Type Unspecified