Healthcare Provider Details

I. General information

NPI: 1558187518
Provider Name (Legal Business Name): MICHAEL WILLIAM LAGANA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 CROWS MILL RD
FORDS NJ
08863-2203
US

IV. Provider business mailing address

341 CROWS MILL RD
FORDS NJ
08863-2203
US

V. Phone/Fax

Practice location:
  • Phone: 732-661-1121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00808400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: