Provider Demographics
NPI:1851300511
Name:HANSEN, TAMMY (DC)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10814A HIGHWAY 21
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050-5208
Mailing Address - Country:US
Mailing Address - Phone:636-789-2400
Mailing Address - Fax:636-789-3800
Practice Address - Street 1:10814A HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-5208
Practice Address - Country:US
Practice Address - Phone:636-789-2400
Practice Address - Fax:636-789-3800
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001020499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU88822Medicare UPIN