Provider Demographics
NPI:1194716852
Name:HAZEN, STEPHEN H (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:H
Last Name:HAZEN
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 1:2932 S RICHARDS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-5986
Mailing Address - Country:US
Mailing Address - Phone:505-473-0000
Mailing Address - Fax:505-473-5315
Practice Address - Street 1:2932 S RICHARDS AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-5986
Practice Address - Country:US
Practice Address - Phone:505-473-0000
Practice Address - Fax:505-473-5315
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM783111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition