Provider Demographics
NPI:1376732164
Name:HAGENSICK CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:HAGENSICK CHIROPRACTIC CLINIC, P.C.
Other - Org Name:FAMILY CHIROPRACTIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:F
Authorized Official - Last Name:HAGENSICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-568-3445
Mailing Address - Street 1:210 7TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-2060
Mailing Address - Country:US
Mailing Address - Phone:563-568-3445
Mailing Address - Fax:563-568-3426
Practice Address - Street 1:210 7TH AVE SE
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-2060
Practice Address - Country:US
Practice Address - Phone:563-568-3445
Practice Address - Fax:563-568-3426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty