Provider Demographics
NPI:1730189903
Name:HANSON, MARK LEONARD (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEONARD
Last Name:HANSON
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 542874
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75354-2874
Mailing Address - Country:US
Mailing Address - Phone:972-243-0022
Mailing Address - Fax:972-243-0550
Practice Address - Street 1:11441 N STEMMONS FWY STE 241
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-2251
Practice Address - Country:US
Practice Address - Phone:972-243-0022
Practice Address - Fax:972-243-0550
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4238111N00000X
TXAC00179171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB128525Medicare Oscar/Certification