Provider Demographics
NPI:1093043259
Name:HANSEN, ASA NELS (DC)
Entity type:Individual
Prefix:DR
First Name:ASA
Middle Name:NELS
Last Name:HANSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 STATION DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327
Mailing Address - Country:US
Mailing Address - Phone:253-912-9653
Mailing Address - Fax:253-912-9660
Practice Address - Street 1:1000 STATION DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327
Practice Address - Country:US
Practice Address - Phone:253-912-9653
Practice Address - Fax:253-912-9660
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WICH60127381111N00000X
WACH60127381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8887654Medicare UPIN