Provider Demographics
NPI:1598002826
Name:HANSON, AMY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:HANSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:SCHAEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1550 NW EASTMAN PKWY STE 265
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3860
Mailing Address - Country:US
Mailing Address - Phone:503-669-1966
Mailing Address - Fax:503-669-1966
Practice Address - Street 1:1550 NW EASTMAN PKWY STE 265
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3860
Practice Address - Country:US
Practice Address - Phone:503-669-1966
Practice Address - Fax:503-667-6599
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500719946Medicaid