Provider Demographics
NPI:1790847200
Name:HANSON, SCOTT BURTON (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BURTON
Last Name:HANSON
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 1:3314 E 46TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2926
Mailing Address - Country:US
Mailing Address - Phone:918-587-7111
Mailing Address - Fax:918-587-1177
Practice Address - Street 1:3314 E 46TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2926
Practice Address - Country:US
Practice Address - Phone:918-587-7111
Practice Address - Fax:918-587-1177
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$Medicare PIN