Provider Demographics
NPI:1649395054
Name:HAGEN, CHAD MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:MICHAEL
Last Name:HAGEN
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 1:2395 TECH DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3277
Mailing Address - Country:US
Mailing Address - Phone:563-449-8153
Mailing Address - Fax:563-449-8154
Practice Address - Street 1:2395 TECH DR
Practice Address - Street 2:SUITE 3
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3277
Practice Address - Country:US
Practice Address - Phone:563-449-8153
Practice Address - Fax:563-449-8154
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06839111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI17012Medicare ID - Type Unspecified
IAV08363Medicare UPIN