Provider Demographics
NPI:1790779171
Name:HANSEN, DAVID J (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
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 1:514 28 1/4 RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-4961
Mailing Address - Country:US
Mailing Address - Phone:970-242-8162
Mailing Address - Fax:970-245-4308
Practice Address - Street 1:514 28 1/4 RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-4961
Practice Address - Country:US
Practice Address - Phone:970-242-8162
Practice Address - Fax:970-245-4308
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4056111N00000X
MT757CHI-INACTIVE111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1518160365OtherGROUP NPI
COT60477Medicare UPIN
CO1518160365OtherGROUP NPI
COC487458Medicare PIN