Provider Demographics
NPI:1538661202
Name:HANSEN, BETHANIE (DC)
Entity Type:Individual
Prefix:DR
First Name:BETHANIE
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 GLENWOOD AVE SE APT 225
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1994
Mailing Address - Country:US
Mailing Address - Phone:231-409-3149
Mailing Address - Fax:
Practice Address - Street 1:2125 PACE ST STE B
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-6660
Practice Address - Country:US
Practice Address - Phone:770-786-2818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor