Provider Demographics
NPI:1215470570
Name:HAGENSICK, TAMMI LYNN (DC)
Entity type:Individual
Prefix:
First Name:TAMMI
Middle Name:LYNN
Last Name:HAGENSICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:DEFOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-1258
Mailing Address - Country:US
Mailing Address - Phone:608-846-3337
Mailing Address - Fax:608-846-7033
Practice Address - Street 1:725 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-2811
Practice Address - Country:US
Practice Address - Phone:608-837-7600
Practice Address - Fax:608-837-0633
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5227-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor