Healthcare Provider Details

I. General information

NPI: 1962520429
Provider Name (Legal Business Name): ROBERT JENE HOAGLAND D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 1ST ST
LOS ALTOS CA
94022-3605
US

IV. Provider business mailing address

381 FIRST ST.
LOS ALTOS CA
94022-3634
US

V. Phone/Fax

Practice location:
  • Phone: 650-941-1723
  • Fax: 650-917-1896
Mailing address:
  • Phone: 650-387-4049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number22368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: