Provider Demographics
NPI:1619046166
Name:HAGAN, MICHAEL CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHARLES
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 1:1738 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
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25448111N00000X
AZ8940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU62718Medicare UPIN
CADC25448Medicare ID - Type Unspecified