Provider Demographics
NPI:1841369220
Name:HAGAN, KENT (DC)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:
Last Name:HAGAN
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 1:95 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1905
Mailing Address - Country:US
Mailing Address - Phone:510-581-5813
Mailing Address - Fax:510-581-7216
Practice Address - Street 1:95 JACKSON ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1905
Practice Address - Country:US
Practice Address - Phone:510-581-5813
Practice Address - Fax:510-581-7216
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA205096608OtherFEDERAL TAX ID NUMBER
CA205096608OtherFEDERAL TAX ID NUMBER