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General NPI Number Information
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NPI Number | 1255587952
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Entity Type | Organization
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Legal Business Name | KENT HAGAN CHIROPRACTIC, INC
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 95 JACKSON ST
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City | HAYWARD
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State | CA
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Zip | 94544-1905
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Country | US
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Telephone | 510-581-5813
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Fax | 510-581-7216
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Provider Business Mailing Address
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Address Line | 95 JACKSON ST
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City | HAYWARD
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State | CA
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Zip | 94544-1905
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Country | US
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Telephone | 510-581-5813
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Fax | 510-581-7216
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Authorized Official
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Title or Position | CEO
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Name | MR. KENT WILLIAM HAGAN
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Credential | D.C.
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Telephone | 510-581-5813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC19813
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License Number State | CA
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