Provider Demographics
NPI:1760407530
Name:HANSEL, JONATHAN M (DC MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:HANSEL
Suffix:
Gender:M
Credentials:DC MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23479 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2962
Mailing Address - Country:US
Mailing Address - Phone:503-667-9300
Mailing Address - Fax:503-667-4975
Practice Address - Street 1:23479 SE STARK ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2962
Practice Address - Country:US
Practice Address - Phone:503-667-9300
Practice Address - Fax:503-667-4975
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273026111N00000X
OR0933175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU72454Medicare UPIN