Provider Demographics
NPI:1639277817
Name:HANSON, HEIDI LYN (DC)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:LYN
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 1:3003 32ND AVE S STE 4
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6163
Mailing Address - Country:US
Mailing Address - Phone:701-234-0733
Mailing Address - Fax:701-234-0733
Practice Address - Street 1:3003 32ND AVE S STE 4
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6163
Practice Address - Country:US
Practice Address - Phone:701-234-0733
Practice Address - Fax:701-234-0733
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor