Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | 2301009692 | MI |
N | 111NR0400X | Rehabilitation Chiropractor | 3340 | NC |
Y | 111NR0400X | Rehabilitation Chiropractor | CHIR007856 | GA |
N | 111NR0400X | Rehabilitation Chiropractor | DC008773 | PA |
NPI | 1407923063 |
---|---|
Provider Name | Dr. Edward Anthony Hagerich |
First Address | Cumming, GA 30040-4216 |
Second Address | Cumming, GA 30040-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 22/05/2013 |