Provider Demographics
NPI:1780626200
Name:HASELDEN, PHILIP HENRY JR (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:HENRY
Last Name:HASELDEN
Suffix:JR
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 1:320 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5764
Mailing Address - Country:US
Mailing Address - Phone:407-847-9680
Mailing Address - Fax:407-847-0607
Practice Address - Street 1:320 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5764
Practice Address - Country:US
Practice Address - Phone:407-847-9680
Practice Address - Fax:407-847-0607
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0002327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89790Medicare ID - Type UnspecifiedMEDICARE PROVIDER #