Provider Demographics
NPI:1326346909
Name:HAGEN CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:HAGEN CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-672-1822
Mailing Address - Street 1:19713 SCRIBER LAKE RD STE G
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6162
Mailing Address - Country:US
Mailing Address - Phone:425-672-1822
Mailing Address - Fax:425-744-0996
Practice Address - Street 1:19713 SCRIBER LAKE RD STE G
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6162
Practice Address - Country:US
Practice Address - Phone:425-672-1822
Practice Address - Fax:425-744-0996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001795305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG001200958Medicare UPIN