Provider Demographics
NPI:1508206764
Name:HAGAR, JORDAN PAUL (DC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:PAUL
Last Name:HAGAR
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 1:1523 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4164
Mailing Address - Country:US
Mailing Address - Phone:515-227-7491
Mailing Address - Fax:888-834-8986
Practice Address - Street 1:1523 2ND AVE N
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4164
Practice Address - Country:US
Practice Address - Phone:515-227-7491
Practice Address - Fax:888-834-8986
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor