Provider Demographics
NPI:1316484348
Name:HAGEN, KEVEN (DC)
Entity type:Individual
Prefix:DR
First Name:KEVEN
Middle Name:
Last Name:HAGEN
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 1:10 ASSEMBLY DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-9604
Mailing Address - Country:US
Mailing Address - Phone:585-497-7078
Mailing Address - Fax:
Practice Address - Street 1:10 ASSEMBLY DR STE 105
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:NY
Practice Address - Zip Code:14506-9604
Practice Address - Country:US
Practice Address - Phone:585-497-7078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012925111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor