Provider Demographics
NPI:1043494552
Name:HAGEN, DAVID (ND)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:HAGEN
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10405 N SCOTTSDALE RD
Mailing Address - Street 2:STE. # 5
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-4555
Mailing Address - Country:US
Mailing Address - Phone:480-229-7252
Mailing Address - Fax:
Practice Address - Street 1:10405 N SCOTTSDALE RD
Practice Address - Street 2:STE. # 5
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-4555
Practice Address - Country:US
Practice Address - Phone:480-229-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07-1040175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath