Provider Demographics
NPI:1518248194
Name:HAGGERTY, LENA GRACE (DC)
Entity Type:Individual
Prefix:DR
First Name:LENA
Middle Name:GRACE
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12891 STATE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-3971
Mailing Address - Country:US
Mailing Address - Phone:440-230-2300
Mailing Address - Fax:440-230-2301
Practice Address - Street 1:12891 STATE RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-3971
Practice Address - Country:US
Practice Address - Phone:440-230-2300
Practice Address - Fax:440-230-2301
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor