MEDICARE: HAGEN CHIROPRACTIC GROUP, INC., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00001054	WA

General Provider Information

NPI Number	:	1164695342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAGEN CHIROPRACTIC GROUP, INC., P.C.

Provider Business Mailing Address
First Line	:	8221 NE HAZEL DELL AVE STE 104
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98665-8153
Country	:	US
Telephone Number	:	360-573-0729
Fax Number	:	360-573-0797

Provider Business Practice Location Address
First Line	:	8221 NE HAZEL DELL AVE STE 104
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98665-8153
Country	:	US
Telephone Number	:	360-573-0729
Fax Number	:	360-573-0797

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN M. HAGEN
Credential	:	D.C.
Telephone Number	:	360-573-0729

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	04/08/2008

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