Hagen Chiropractic, LTD.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

4507-012 Issued in WI

Legal business name

HAGEN CHIROPRACTIC, LTD.

Practice address

529 Mill St
Green Lake, WI 54941-9425

Phone

(920) 294-4357

NPI assigned

Dec 7, 2009

Last updated

Dec 7, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ethan H Hagen, D.C.

Title

President

Phone

(920) 294-4357

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1260144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260144000000",
    "number": "1740518554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 336",
            "city": "GREEN LAKE",
            "state": "WI",
            "postal_code": "549410336",
            "telephone_number": "920-294-4357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 MILL ST",
            "city": "GREEN LAKE",
            "state": "WI",
            "postal_code": "549419425",
            "telephone_number": "920-294-4357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAGEN CHIROPRACTIC, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-07",
        "last_updated": "2009-12-07",
        "status": "A",
        "authorized_official_last_name": "HAGEN",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-294-4357",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WI",
            "license": "4507-012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Jean Gimenez, RN, BSN, MS
• Green Lake County Senior Transportation, Inc
• Green Lake Medical Clinic
• Green Lake Medical Clinic , S.C.
• Green Lake School District
• Kellie Elizabeth Helmer, MSN, APNP, PMHNP-BC
• Trina Hernandez, APNP
• Amanda M Hetzel, DC
• Amy M Higginbotham, MS
• Higher Hope Mental Health, LLC

• Clinic/Center in Green Lake, WI
• Providers in Green Lake, WI by specialty
• Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.