Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH00001176 | WA |
NPI | 1710060587 |
---|---|
Provider Name | Kirk Richard Hansen |
First Address | Lacey, WA 98506 |
Second Address | Lacey, WA 98503-6101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1106388 | COMM HEALTH PLAN OF WA (01) | WA |
2015907 | (05) | WA |
49846 | DEPT OF LABOR & INDUSTRIE (01) | WA |
T02714 | (02) |