Provider Demographics
NPI:1477691665
Name:HAGGARD, DAVID EARL (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EARL
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 1:4108 N 49TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-2320
Mailing Address - Country:US
Mailing Address - Phone:623-247-5577
Mailing Address - Fax:623-247-7203
Practice Address - Street 1:4108 N 49TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-2320
Practice Address - Country:US
Practice Address - Phone:623-247-5577
Practice Address - Fax:623-247-7203
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0084330OtherBCBS
AZT41684Medicare UPIN
AZZ24854Medicare ID - Type UnspecifiedGROUP
AZAZ0084330OtherBCBS