Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 10787299-2401 | UT |
Y | 213ES0000X | Sports Medicine | 10787299-2401 | UT |
NPI | 1053887067 |
---|---|
Provider Name | Dr. Chase K Hansen |
First Address | Salt Lake City, UT 84106-2531 |
Second Address | Salt Lake City, UT 84106-2531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2018 |
Last Update Date | 17/10/2018 |