Provider Demographics
NPI:1700487022
Name:HAUGEN, CODY LANCE (DC)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:LANCE
Last Name:HAUGEN
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 1:300 3RD AVE SW STE F
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4346
Mailing Address - Country:US
Mailing Address - Phone:701-833-0090
Mailing Address - Fax:701-838-6892
Practice Address - Street 1:300 3RD AVE SW STE F
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4346
Practice Address - Country:US
Practice Address - Phone:701-833-0090
Practice Address - Fax:701-838-6892
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor