Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038012477 | IL |
N | 111NN1001X | Nutrition | 038012477 | IL |
N | 111NP0017X | Pediatric Chiropractor | 038012477 | IL |
NPI | 1629417605 |
---|---|
Provider Name | Dr. David Hanson |
First Address | Batavia, IL 60510-2794 |
Second Address | Batavia, IL 60510-2794 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2013 |
Last Update Date | 23/06/2013 |