Provider Demographics
NPI:1497535413
Name:JAGGI, BRETTON (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETTON
Middle Name:
Last Name:JAGGI
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 1:550 50TH AVE N APT 1
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-2917
Mailing Address - Country:US
Mailing Address - Phone:608-212-6906
Mailing Address - Fax:
Practice Address - Street 1:550 50TH AVE N APT 1
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-2917
Practice Address - Country:US
Practice Address - Phone:608-212-6906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor