Provider Demographics
NPI:1306962378
Name:GAGNON, DOUGLAS DANIEL (DC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:DANIEL
Last Name:GAGNON
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 1:14388 TANGERINE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-5337
Mailing Address - Country:US
Mailing Address - Phone:561-790-4475
Mailing Address - Fax:
Practice Address - Street 1:5460 N STATE ROAD 7
Practice Address - Street 2:SUITE 112
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33319-2952
Practice Address - Country:US
Practice Address - Phone:954-735-3339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor