Provider Demographics
NPI:1154338606
Name:HANSON, RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:HANSON
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 1:500 PINE ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-5384
Mailing Address - Country:US
Mailing Address - Phone:716-644-0445
Mailing Address - Fax:716-644-0577
Practice Address - Street 1:500 PINE ST
Practice Address - Street 2:SUITE #2
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5384
Practice Address - Country:US
Practice Address - Phone:716-644-0445
Practice Address - Fax:716-644-0577
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02905622Medicaid
NYIA1131Medicare PIN
NYU05520Medicare UPIN