Provider Demographics
NPI:1497770739
Name:HAGER, ALLEN L (DC)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:L
Last Name:HAGER
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-3300
Practice Address - Fax:701-364-8906
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1577849OtherAMERICA'S PPO/ARAZ #
ND21754OtherNDBS #
ND11840Medicaid
ND29537700Medicaid
ND34517OtherSIOUX VALLEY #
ND56G74HAOtherMNBS #
NDHP39955OtherHEALTHPARTNERS #
ND1577849OtherAMERICA'S PPO/ARAZ #
ND34517OtherSIOUX VALLEY #
ND350054376Medicare ID - Type UnspecifiedRR MEDICARE #