Provider Demographics
NPI:1609091180
Name:HAGLUND, MATTHEW ERIC (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ERIC
Last Name:HAGLUND
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 1:10708 EAST CARSON CITY ROAD
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811
Mailing Address - Country:US
Mailing Address - Phone:989-584-6110
Mailing Address - Fax:989-584-9929
Practice Address - Street 1:10708 E CARSON CITY ROAD
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811
Practice Address - Country:US
Practice Address - Phone:989-584-6110
Practice Address - Fax:989-584-9929
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005228111N00000X
MI27309111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95OE910310OtherBCBS OF MICHIGAN
MI200000005749OtherPHYSICIANS HEALTH PLAN
MIT96826Medicare UPIN
MI200000005749OtherPHYSICIANS HEALTH PLAN