Provider Demographics
NPI:1821260423
Name:HAGGARD CHIROPRACTIC II LLC
Entity Type:Organization
Organization Name:HAGGARD CHIROPRACTIC II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CA
Authorized Official - Prefix:
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-322-1925
Mailing Address - Street 1:8278 W LAKE PLEASANT PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7441
Mailing Address - Country:US
Mailing Address - Phone:623-322-1925
Mailing Address - Fax:201-246-6678
Practice Address - Street 1:8278 W LAKE PLEASANT PKWY STE 103
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7441
Practice Address - Country:US
Practice Address - Phone:623-322-1925
Practice Address - Fax:201-246-6678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0934710OtherAZBLS
AZZ69376OtherMEDICARE GROUP
AZAZ0934710OtherAZBLS
AZZ72871Medicare UPIN