Provider Demographics
NPI:1881830297
Name:HAUG CHIROPRACTIC CLINIC, P.A.
Entity Type:Organization
Organization Name:HAUG CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HAUG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-983-2458
Mailing Address - Street 1:113 S A ST
Mailing Address - Street 2:PO BOX 8
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530-1428
Mailing Address - Country:US
Mailing Address - Phone:208-983-2458
Mailing Address - Fax:208-983-1554
Practice Address - Street 1:113 S A ST
Practice Address - Street 2:
Practice Address - City:GRANGEVILLE
Practice Address - State:ID
Practice Address - Zip Code:83530-1428
Practice Address - Country:US
Practice Address - Phone:208-983-2458
Practice Address - Fax:208-983-1554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC552261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1023175734OtherNPI #