Provider Demographics
NPI:1073705463
Name:HAGER, BOBBY ROLAND (DC)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:ROLAND
Last Name:HAGER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2499 E OZARK AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1421
Mailing Address - Country:US
Mailing Address - Phone:704-865-5664
Mailing Address - Fax:704-865-7348
Practice Address - Street 1:2499 E OZARK AVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-1421
Practice Address - Country:US
Practice Address - Phone:704-865-5664
Practice Address - Fax:704-865-7348
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3753111N00000X
SC3060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor