Provider Demographics
NPI:1639110232
Name:HANSEN, TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
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 1:2270 NW TROOST ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-6006
Mailing Address - Country:US
Mailing Address - Phone:541-464-0808
Mailing Address - Fax:541-464-0809
Practice Address - Street 1:2270 NW TROOST ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-6006
Practice Address - Country:US
Practice Address - Phone:541-464-0808
Practice Address - Fax:541-464-0809
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR931245409OtherTAX ID
OR931245409OtherTAX ID
ORR114213Medicare ID - Type Unspecified