Provider Demographics
NPI:1477720373
Name:HASEGAWA, TETSUYA (DC)
Entity Type:Individual
Prefix:DR
First Name:TETSUYA
Middle Name:
Last Name:HASEGAWA
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 1:1221 ARISTA ROAD
Mailing Address - Street 2:150
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032
Mailing Address - Country:US
Mailing Address - Phone:214-797-6560
Mailing Address - Fax:214-615-6518
Practice Address - Street 1:1221 ARISTA ROAD
Practice Address - Street 2:150
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032
Practice Address - Country:US
Practice Address - Phone:214-797-6560
Practice Address - Fax:214-615-6518
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-11
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor