Provider Demographics
NPI:1811034754
Name:HAGGERTY, BRIAN P (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:P
Last Name:HAGGERTY
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:PO BOX 8587
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33443-8587
Mailing Address - Country:US
Mailing Address - Phone:954-570-7699
Mailing Address - Fax:954-570-7698
Practice Address - Street 1:910 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-2138
Practice Address - Country:US
Practice Address - Phone:954-570-7699
Practice Address - Fax:954-570-7698
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-7618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3224470OtherCIGNA PROVIDER NUMBER
FL2100148OtherFIRST HEALTH PROVIDER #
FL40974OtherBCBS GROUP NUMBER
FL55805OtherBCBS PROVIDER NUMBER
FL647625OtherUNITED HEALTHCARE
FLU94943Medicare UPIN
FL55805Medicare ID - Type UnspecifiedPROVIDER NUMBER