Provider Demographics
NPI:1710060587
Name:HANSEN, KIRK RICHARD (DC)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:RICHARD
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 1:130 MARVIN RD SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-357-9477
Mailing Address - Fax:
Practice Address - Street 1:130 MARVIN RD SE
Practice Address - Street 2:SUITE 100
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-6101
Practice Address - Country:US
Practice Address - Phone:360-357-9477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001176111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1106388OtherCOMM HEALTH PLAN OF WA
WA49846OtherDEPT OF LABOR & INDUSTRIE
WA2015907Medicaid
WA49846OtherDEPT OF LABOR & INDUSTRIE