MEDICARE: SCP CHIROPRACTIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	5638	AZ

General Provider Information

NPI Number	:	1982889473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCP CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	4767 N 20TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4706
Country	:	US
Telephone Number	:	602-631-4500
Fax Number	:	602-631-4427

Provider Business Practice Location Address
First Line	:	4767 N 20TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4706
Country	:	US
Telephone Number	:	602-631-4500
Fax Number	:	602-631-4427

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSHUA HAGGARD
Credential	:	DC
Telephone Number	:	602-631-4500

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	03/17/2017

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