Provider Demographics
NPI:1902945520
Name:HANSON, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 ROOSEVELT WAY NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6242
Mailing Address - Country:US
Mailing Address - Phone:206-306-2494
Mailing Address - Fax:206-306-9351
Practice Address - Street 1:3002 NE 127TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125
Practice Address - Country:US
Practice Address - Phone:206-306-2494
Practice Address - Fax:206-306-9351
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA146277OtherWA L AND I PROVIDER NUMBER
WA146277OtherWA L AND I PROVIDER NUMBER