Provider Demographics
NPI:1619095957
Name:HAGMAN, JASON ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ERIC
Last Name:HAGMAN
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 1:454 MORRIS AVE STE L1
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1158
Mailing Address - Country:US
Mailing Address - Phone:973-564-7676
Mailing Address - Fax:973-379-6888
Practice Address - Street 1:454 MORRIS AVE STE L1
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1158
Practice Address - Country:US
Practice Address - Phone:973-564-7676
Practice Address - Fax:973-379-6888
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00580200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ052580Medicare ID - Type Unspecified