Provider Demographics
NPI:1649340605
Name:HANSEN, JILLIAN JAN (DC)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:JAN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:JAN
Other - Last Name:WELTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:IA
Mailing Address - Zip Code:50597-0297
Mailing Address - Country:US
Mailing Address - Phone:515-887-3811
Mailing Address - Fax:515-887-2568
Practice Address - Street 1:323 SOUTH BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:IA
Practice Address - Zip Code:50597-0297
Practice Address - Country:US
Practice Address - Phone:515-887-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor