Provider Demographics
NPI:1639448657
Name:DUANE L HANSON BS, DC, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DUANE L HANSON BS, DC, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-341-4653
Mailing Address - Street 1:1717 SOUTH BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5145
Mailing Address - Country:US
Mailing Address - Phone:405-314-4653
Mailing Address - Fax:405-341-8718
Practice Address - Street 1:1717 SOUTH BOULEVARD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5145
Practice Address - Country:US
Practice Address - Phone:405-314-4653
Practice Address - Fax:405-341-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQDBVFMedicare PIN