Provider Demographics
NPI:1720381858
Name:HAZZARD, DAWN (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:
Last Name:HAZZARD
Suffix:
Gender:F
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 BUCCANEER CT
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-4135
Mailing Address - Country:US
Mailing Address - Phone:678-521-8060
Mailing Address - Fax:
Practice Address - Street 1:4627 CLARY LAKES DR NE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5446
Practice Address - Country:US
Practice Address - Phone:678-521-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-12
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor