Healthcare Provider Details

I. General information

NPI: 1336118934
Provider Name (Legal Business Name): RICHARD JOSEPH HAGES JR. D.C., C.C.S.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 VETERANS MEMORIAL BLVD #39
METAIRIE LA
70003-3943
US

IV. Provider business mailing address

6601 VETERANS MEMORIAL BLVD #39
METAIRIE LA
70003-3943
US

V. Phone/Fax

Practice location:
  • Phone: 504-455-4302
  • Fax: 504-455-7800
Mailing address:
  • Phone: 504-455-4302
  • Fax: 504-455-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number269
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number767
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5601
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2852
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: