Provider Demographics
NPI:1639187636
Name:HASSE, ROBERT L (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:HASSE
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 1:205 SHEYENNE ST
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-1752
Mailing Address - Country:US
Mailing Address - Phone:701-282-2919
Mailing Address - Fax:701-282-2932
Practice Address - Street 1:205 SHEYENNE ST
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-1752
Practice Address - Country:US
Practice Address - Phone:701-282-2919
Practice Address - Fax:701-282-2932
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDHA521761OtherBLUE CROSS BLUE SHIELD
ND0166881Medicaid
350054822OtherRAILROAD MEDICARE
ND0166881Medicaid
21761Medicare ID - Type Unspecified