Provider Demographics
NPI:1033190293
Name:HAGEN, MARK PALMER (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:PALMER
Last Name:HAGEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:CLELAND
Other - Last Name:HAGEN
Other - Suffix:SR
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:515 S CLIFF AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-5330
Mailing Address - Country:US
Mailing Address - Phone:605-361-6824
Mailing Address - Fax:605-333-0441
Practice Address - Street 1:3405 S KIWANIS AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4213
Practice Address - Country:US
Practice Address - Phone:605-361-6824
Practice Address - Fax:605-333-0441
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor