Provider Demographics
NPI:1073501342
Name:HAZARD, JAMES EDGAR JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDGAR
Last Name:HAZARD
Suffix:JR
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:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:SANTA YNEZ
Mailing Address - State:CA
Mailing Address - Zip Code:93460-0142
Mailing Address - Country:US
Mailing Address - Phone:805-686-2064
Mailing Address - Fax:866-877-6771
Practice Address - Street 1:3669 SAGUNTO ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SANTA YNEZ
Practice Address - State:CA
Practice Address - Zip Code:93460-9151
Practice Address - Country:US
Practice Address - Phone:805-686-2064
Practice Address - Fax:866-877-6771
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22364111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician