Provider Demographics
NPI:1316130263
Name:M HANSON INC
Entity type:Organization
Organization Name:M HANSON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:214-616-3355
Mailing Address - Street 1:1615 W OLEANDER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4025
Mailing Address - Country:US
Mailing Address - Phone:214-616-3355
Mailing Address - Fax:817-632-5007
Practice Address - Street 1:1615 W OLEANDER ST
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4025
Practice Address - Country:US
Practice Address - Phone:214-616-3355
Practice Address - Fax:817-632-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00179171100000X
TX4238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0080PXOtherDC, LAC
TX8AK410OtherDC, LAC
TXACN 672228OtherDC, LAC
TX8M8486OtherDC, LAC