Provider Demographics
NPI:1972854180
Name:HANSEN, ANITA BORG (DC)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:BORG
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 1:23838 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 702
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-1513
Mailing Address - Country:US
Mailing Address - Phone:424-644-9063
Mailing Address - Fax:
Practice Address - Street 1:23838 PACIFIC COAST HWY
Practice Address - Street 2:#702
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-1513
Practice Address - Country:US
Practice Address - Phone:424-644-9063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor