Provider Demographics
NPI:1730261710
Name:HAGEN, PAUL JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAMES
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 1:2480 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-2922
Mailing Address - Country:US
Mailing Address - Phone:716-692-2799
Mailing Address - Fax:716-692-2799
Practice Address - Street 1:2480 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-2922
Practice Address - Country:US
Practice Address - Phone:716-692-2799
Practice Address - Fax:716-692-2799
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor