Provider Demographics
NPI:1548568629
Name:HANSEN, JACOB HYDE (DC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:HYDE
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 1:4625 TRAIL BOSS DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2803
Mailing Address - Country:US
Mailing Address - Phone:720-893-2225
Mailing Address - Fax:
Practice Address - Street 1:4625 TRAIL BOSS DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2803
Practice Address - Country:US
Practice Address - Phone:925-449-3356
Practice Address - Fax:925-449-5229
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR0007032111N00000X
CADC31942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
821009639OtherWAITING FOR MEDICARE NUMBER TO COME THROUGH