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Individual

KIRK RICHARD HANSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DC

Contact information

Practice address
130 MARVIN RD SE, SUITE 100, LACEY, WA 98503-6101
(360) 357-9477
Mailing address
130 MARVIN RD SE, SUITE 100, LACEY, WA 98506
(360) 357-9477

Taxonomy

Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
CH00001176
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1106388
COMM HEALTH PLAN OF WA
WA
05
2015907
WA
01
49846
DEPT OF LABOR & INDUSTRIE
WA
Enumeration date
10/23/2006
Last updated
07/08/2007
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