Healthcare Provider Details

I. General information

NPI: 1073676664
Provider Name (Legal Business Name): HAGERICH ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7854 ALEXANDER PROMENADE PL SUITE 110
RALEIGH NC
27617-7833
US

IV. Provider business mailing address

7854 ALEXANDER PROMENADE PL SUITE 110
RALEIGH NC
27617-7833
US

V. Phone/Fax

Practice location:
  • Phone: 919-957-3600
  • Fax: 919-957-3800
Mailing address:
  • Phone: 919-957-3600
  • Fax: 919-957-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. EDWARD ANTHONY HAGERICH
Title or Position: OWNER
Credential: D.C.
Phone: 919-957-3600