Provider Demographics
NPI:1174645279
Name:HAGGARD, WALTER DARREL (DC)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:DARREL
Last Name:HAGGARD
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 1:18205 N 51ST AVE
Mailing Address - Street 2:SUITE 147
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1490
Mailing Address - Country:US
Mailing Address - Phone:602-997-7531
Mailing Address - Fax:602-997-7797
Practice Address - Street 1:18205 N 51ST AVE
Practice Address - Street 2:SUITE 147
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1490
Practice Address - Country:US
Practice Address - Phone:602-997-7531
Practice Address - Fax:602-997-7797
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor