Provider Demographics
NPI:1760475263
Name:HAGENE, LOUIS EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:EDWARD
Last Name:HAGENE
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 1:114 S BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-1339
Mailing Address - Country:US
Mailing Address - Phone:573-885-3353
Mailing Address - Fax:573-885-3539
Practice Address - Street 1:114 S BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453-1241
Practice Address - Country:US
Practice Address - Phone:573-885-3353
Practice Address - Fax:573-885-3539
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1669557583Medicare NSC
MO31572Medicare ID - Type Unspecified