Provider Demographics
NPI:1407967532
Name:HANSEN, KIPLING GAYLE (DC)
Entity type:Individual
Prefix:DR
First Name:KIPLING
Middle Name:GAYLE
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 1:6212 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1163
Mailing Address - Country:US
Mailing Address - Phone:702-877-6767
Mailing Address - Fax:702-877-6434
Practice Address - Street 1:6212 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1163
Practice Address - Country:US
Practice Address - Phone:702-877-6767
Practice Address - Fax:702-877-6434
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-220111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV30235Medicare ID - Type Unspecified