Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CH00002391 | WA |
N | 111NR0400X | Rehabilitation Chiropractor | CH00002391 | WA |
Y | 111NS0005X | Chiropractic Sports Physician | CH00002391 | WA |
NPI | 1134258106 |
---|---|
Provider Name | Davin L Hagman |
First Address | Maple Valley, WA 98038-8232 |
Second Address | Maple Valley, WA 98038-8232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 28/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
131643 | BLUE CROSS (01) | WA |
54553 | LABOR AND INDUSTRIES (01) | WA |