Provider Demographics
NPI:1518009786
Name:HAGAN CHIROPRACTIC, APC
Entity Type:Organization
Organization Name:HAGAN CHIROPRACTIC, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-354-5022
Mailing Address - Street 1:1738 HWAY 95
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-6903
Mailing Address - Country:US
Mailing Address - Phone:928-299-2260
Mailing Address - Fax:858-298-3125
Practice Address - Street 1:1738 HWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6903
Practice Address - Country:US
Practice Address - Phone:928-299-2260
Practice Address - Fax:858-298-3125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25448111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA25448OtherSTATE LICENSE
AZ8940OtherSTATE LICENSE