Healthcare Provider Details

I. General information

NPI: 1073501342
Provider Name (Legal Business Name): JAMES EDGAR HAZARD JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3669 SAGUNTO ST SUITE 106
SANTA YNEZ CA
93460-9151
US

IV. Provider business mailing address

PO BOX 142
SANTA YNEZ CA
93460-0142
US

V. Phone/Fax

Practice location:
  • Phone: 805-686-2064
  • Fax: 866-877-6771
Mailing address:
  • Phone: 805-686-2064
  • Fax: 866-877-6771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC22364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: