Provider Demographics
NPI:1568471811
Name:HAGAN, BRAD JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:JAMES
Last Name:HAGAN
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 1:429 HIGHWAY 52 BYP W
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-1731
Mailing Address - Country:US
Mailing Address - Phone:615-688-2225
Mailing Address - Fax:615-688-4249
Practice Address - Street 1:429 HIGHWAY 52 BYP W
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1731
Practice Address - Country:US
Practice Address - Phone:615-688-2225
Practice Address - Fax:615-688-4249
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT74491Medicare UPIN