Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH00000937 | WA |
NPI | 1225110216 |
---|---|
Provider Name | Dr. Raymond Theodore Hanson |
First Address | Port Angeles, WA 98362-9374 |
Second Address | Port Angeles, WA 98362-6251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 08/07/2007 |