Provider Demographics
NPI:1689739906
Name:HANSEN, LARRY NELS (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:NELS
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 1:1107 S 347TH PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6718
Mailing Address - Country:US
Mailing Address - Phone:253-838-3777
Mailing Address - Fax:253-874-6874
Practice Address - Street 1:1107 S 347TH PL
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6718
Practice Address - Country:US
Practice Address - Phone:253-838-3777
Practice Address - Fax:253-874-6874
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8918984Medicare UPIN
WA8850516Medicare ID - Type Unspecified
WAT60909Medicare UPIN