Provider Demographics
NPI:1972660686
Name:HAGERTY, TERI J
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:J
Last Name:HAGERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:J
Other - Last Name:HAGERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:10291 EUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-9405
Mailing Address - Country:US
Mailing Address - Phone:941-473-3804
Mailing Address - Fax:941-473-8534
Practice Address - Street 1:10291 EUSTON AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-9405
Practice Address - Country:US
Practice Address - Phone:941-473-3804
Practice Address - Fax:941-473-8534
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22280Medicare ID - Type Unspecified
T33481Medicare UPIN