Provider Demographics
NPI:1528043437
Name:HAGAN, TREACY C (DC)
Entity Type:Individual
Prefix:DR
First Name:TREACY
Middle Name:C
Last Name:HAGAN
Suffix:
Gender:F
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:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75958-0159
Mailing Address - Country:US
Mailing Address - Phone:936-560-1113
Mailing Address - Fax:936-560-4225
Practice Address - Street 1:181 COUNTY ROAD 238
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-7305
Practice Address - Country:US
Practice Address - Phone:936-560-1113
Practice Address - Fax:936-560-4225
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A6231OtherBCBS
U48604Medicare UPIN
U48604Medicare UPIN