Provider Demographics
NPI:1578782959
Name:HAGNER, ANTHONY JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:HAGNER
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 1:1020 2ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5057
Mailing Address - Country:US
Mailing Address - Phone:760-452-2997
Mailing Address - Fax:
Practice Address - Street 1:1020 2ND ST STE A
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5057
Practice Address - Country:US
Practice Address - Phone:760-452-2997
Practice Address - Fax:760-452-2998
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor