Provider Demographics
NPI:1144204140
Name:HAGEN, SHAWN D (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:D
Last Name:HAGEN
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 1:19707 SCRIBER LAKE RD
Mailing Address - Street 2:STE 103
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6157
Mailing Address - Country:US
Mailing Address - Phone:425-672-1822
Mailing Address - Fax:425-744-0996
Practice Address - Street 1:19707 SCRIBER LAKE RD
Practice Address - Street 2:STE 103
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6157
Practice Address - Country:US
Practice Address - Phone:425-672-1822
Practice Address - Fax:425-744-0996
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2004950Medicaid
T03081Medicare UPIN
WA001200958Medicare ID - Type Unspecified