Provider Demographics
NPI:1134258106
Name:HAGMAN, DAVIN L (DC)
Entity type:Individual
Prefix:
First Name:DAVIN
Middle Name:L
Last Name:HAGMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24005 MAPLE VALLEY HIGHWAY SE
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-8232
Mailing Address - Country:US
Mailing Address - Phone:425-432-2273
Mailing Address - Fax:425-432-2468
Practice Address - Street 1:24005 MAPLE VALLEY HIGHWAY SE
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8232
Practice Address - Country:US
Practice Address - Phone:425-432-2273
Practice Address - Fax:425-432-2468
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002391111N00000X, 111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA131643OtherBLUE CROSS
WA54553OtherLABOR AND INDUSTRIES