Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | IL | |
N | 111NR0400X | Rehabilitation Chiropractor | IL | |
N | 111NS0005X | Chiropractic Sports Physician | IL | |
N | 111NX0800X | Chiropractor Orthopedic Specialist | IL |
NPI | 1396876348 |
---|---|
Provider Name | Dr. Joseph J. Hansen |
First Address | Glenview, IL 60025-2100 |
Second Address | Glenview, IL 60025-2100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001634903 | BCBS PROVIDER NO. (01) | IL |