Provider Demographics
NPI:1558865485
Name:HANSON, NATALIE MARIE (DC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIE
Last Name:HANSON
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:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:EL GRANADA
Mailing Address - State:CA
Mailing Address - Zip Code:94018-0491
Mailing Address - Country:US
Mailing Address - Phone:650-713-5273
Mailing Address - Fax:
Practice Address - Street 1:30 AVENUE PORTOLA
Practice Address - Street 2:SUITE 2A
Practice Address - City:EL GRANADA
Practice Address - State:CA
Practice Address - Zip Code:94018
Practice Address - Country:US
Practice Address - Phone:650-713-5273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33591111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000OtherNONE