Provider Demographics
NPI:1720029242
Name:HANSEN, ELIZABETH MARJORIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARJORIE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:MARJORIE
Other - Last Name:CONLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1109 LILAC LN
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1127
Mailing Address - Country:US
Mailing Address - Phone:610-670-6683
Mailing Address - Fax:
Practice Address - Street 1:367 W PENN AVE
Practice Address - Street 2:
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-1413
Practice Address - Country:US
Practice Address - Phone:610-670-6333
Practice Address - Fax:610-670-8730
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU94517-LMedicare UPIN
PA086700LZ1Medicare ID - Type Unspecified