Provider Demographics
NPI:1992771984
Name:HANSEN, HEIDI (DC)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1326
Mailing Address - Country:US
Mailing Address - Phone:517-543-6360
Mailing Address - Fax:517-543-7773
Practice Address - Street 1:710 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1326
Practice Address - Country:US
Practice Address - Phone:517-543-6360
Practice Address - Fax:517-543-7773
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor