Provider Demographics
NPI:1851300115
Name:HAGGERTON, JIM BOB (DC)
Entity Type:Individual
Prefix:DR
First Name:JIM BOB
Middle Name:
Last Name:HAGGERTON
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 1:1813 HARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3190
Mailing Address - Country:US
Mailing Address - Phone:817-428-9595
Mailing Address - Fax:817-428-9451
Practice Address - Street 1:1813 HARWOOD CT
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3190
Practice Address - Country:US
Practice Address - Phone:817-428-9595
Practice Address - Fax:817-428-9451
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9744111N00000X
TX10073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX610524Medicare ID - Type Unspecified