Healthcare Provider Details

I. General information

NPI: 1629201116
Provider Name (Legal Business Name): STEPHEN PAUL HAAGENSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S FEDERAL BLVD
DENVER CO
80219-2044
US

IV. Provider business mailing address

50 S FEDERAL BLVD
DENVER CO
80219-2044
US

V. Phone/Fax

Practice location:
  • Phone: 303-922-2977
  • Fax:
Mailing address:
  • Phone: 303-922-2977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6245
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: