MEDICARE: HAGER CHIROPRACTIC HEALTH CLINIC

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	561	WY

General Provider Information

NPI Number	:	1366787640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAGER CHIROPRACTIC HEALTH CLINIC

Provider Business Mailing Address
First Line	:	2708 COMMERCIAL WAY
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4754
Country	:	US
Telephone Number	:	307-362-3700
Fax Number	:	307-362-9429

Provider Business Practice Location Address
First Line	:	2708 COMMERCIAL WAY
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4754
Country	:	US
Telephone Number	:	307-362-3700
Fax Number	:	307-362-9429

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LANCE R HAGER
Credential	:	D.C.
Telephone Number	:	307-362-3700

Provider Enumeration Date	:	11/28/2012
Last Update Date	:	11/28/2012

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