Provider Demographics
NPI:1578507927
Name:HANSEN, SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
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 1:2165 WOODLANE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2916
Mailing Address - Country:US
Mailing Address - Phone:651-735-9353
Mailing Address - Fax:651-735-8282
Practice Address - Street 1:2165 WOODLANE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2916
Practice Address - Country:US
Practice Address - Phone:651-735-9353
Practice Address - Fax:651-735-8282
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN996448700Medicaid
MN5378488OtherSTATE TAX ID
MN007J2LIMedicare UPIN
MN350002410Medicare ID - Type UnspecifiedMEDICARE