Provider Demographics
NPI:1184843799
Name:HAUGH, JORDAN SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:SCOTT
Last Name:HAUGH
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 1:3060 HALLMAN CIR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2499
Mailing Address - Country:US
Mailing Address - Phone:770-420-9538
Mailing Address - Fax:
Practice Address - Street 1:3655 MACLAND RD
Practice Address - Street 2:SUITE C
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2226
Practice Address - Country:US
Practice Address - Phone:770-439-6063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIROO5322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor