Provider Demographics
NPI:1912900721
Name:HANSSEN, JEFF A (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:A
Last Name:HANSSEN
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 1:515 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-4205
Mailing Address - Country:US
Mailing Address - Phone:563-264-1611
Mailing Address - Fax:563-264-5641
Practice Address - Street 1:515 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-4205
Practice Address - Country:US
Practice Address - Phone:563-264-1611
Practice Address - Fax:563-264-5641
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1131466Medicaid
IA47960Medicare PIN
IA1131466Medicaid