Provider Demographics
NPI:1144288457
Name:HAGER, SHAN DANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:SHAN
Middle Name:DANIEL
Last Name:HAGER
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 1:310 LASHLEY ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6056
Mailing Address - Country:US
Mailing Address - Phone:303-774-9737
Mailing Address - Fax:303-774-9738
Practice Address - Street 1:310 LASHLEY ST
Practice Address - Street 2:SUITE 107
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6056
Practice Address - Country:US
Practice Address - Phone:303-774-9737
Practice Address - Fax:303-774-9738
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5489111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO520968Medicare ID - Type Unspecified
COU98425Medicare UPIN