Provider Demographics
NPI:1972675262
Name:HAGGARD, JUSTIN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:DAVID
Last Name:HAGGARD
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 1:8278 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
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0934710OtherBCBS OF AZ PROVIDER NUM.
AZZ72871Medicare UPIN
AZZ69377Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
AZZ69376Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER