Provider Demographics
NPI:1699854802
Name:HAGEN CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:HAGEN CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANEEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-449-8153
Mailing Address - Street 1:2395 TECH DR STE 3
Mailing Address - Street 2:
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 STE 3
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04632111N00000X
IAA05427111N00000X
IAA05805111N00000X
IA06839111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03058OtherWELLMARK BLUE CROSS BLUE
IAI5274Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IAV08363Medicare UPIN
IAT00916Medicare UPIN
IAT95937Medicare UPIN
IA03058OtherWELLMARK BLUE CROSS BLUE