Provider Demographics
NPI:1700259967
Name:CLARK H. HANSEN, N.M.D., LTD
Entity Type:Organization
Organization Name:CLARK H. HANSEN, N.M.D., LTD
Other - Org Name:HANSEN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:HOUSLEY
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:480-991-5092
Mailing Address - Street 1:13840 N NORTHSIGHT BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3665
Mailing Address - Country:US
Mailing Address - Phone:480-991-5092
Mailing Address - Fax:480-991-2027
Practice Address - Street 1:13840 N NORTHSIGHT BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3665
Practice Address - Country:US
Practice Address - Phone:480-991-5092
Practice Address - Fax:480-991-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ87-384175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMH3151292OtherDEA