Healthcare Provider Details

I. General information

NPI: 1407923063
Provider Name (Legal Business Name): EDWARD ANTHONY HAGERICH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 04/05/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5107 NC-55 SUITE 103
DURHAM NC
27713
US

IV. Provider business mailing address

PO BOX 1028
APEX NC
27502-1028
US

V. Phone/Fax

Practice location:
  • Phone: 919-606-1033
  • Fax:
Mailing address:
  • Phone: 919-606-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3340
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: