Provider Demographics
NPI:1396876348
Name:HANSEN, JOSEPH J (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
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 1:1500 WAUKEGAN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2100
Mailing Address - Country:US
Mailing Address - Phone:847-998-1234
Mailing Address - Fax:847-998-1243
Practice Address - Street 1:1500 WAUKEGAN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2100
Practice Address - Country:US
Practice Address - Phone:847-998-1234
Practice Address - Fax:847-998-1243
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NN1001X, 111NR0400X, 111NS0005X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001634903OtherBCBS PROVIDER NO.
IL544370Medicare ID - Type Unspecified