Healthcare Provider Details

I. General information

NPI: 1912721960
Provider Name (Legal Business Name): LOGAN HAGERMAN DC, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10733 BIG BEND RD STE 100
SAINT LOUIS MO
63122-6071
US

IV. Provider business mailing address

10733 BIG BEND RD STE 100
SAINT LOUIS MO
63122-6071
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-5300
  • Fax:
Mailing address:
  • Phone: 314-822-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2021050933
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: