Provider Demographics
NPI:1588691372
Name:HANSEN, DANIEL CHARLES (IDC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:CHARLES
Last Name:HANSEN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 OVERLAND TRL
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-1857
Mailing Address - Country:US
Mailing Address - Phone:361-688-4296
Mailing Address - Fax:
Practice Address - Street 1:730 FORRESTAL ST
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-5112
Practice Address - Country:US
Practice Address - Phone:361-516-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman