Provider Demographics
NPI:1205656808
Name:HAGEN, BRANDON CARL (DC)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:CARL
Last Name:HAGEN
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 1:464 PAULETTE PL
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2728
Mailing Address - Country:US
Mailing Address - Phone:626-379-2375
Mailing Address - Fax:
Practice Address - Street 1:464 PAULETTE PL
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-2728
Practice Address - Country:US
Practice Address - Phone:626-379-2375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC37097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor