Healthcare Provider Details

I. General information

NPI: 1720123359
Provider Name (Legal Business Name): BRIAN P HAGGERTY DC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 NE 2ND ST
DEERFIELD BEACH FL
33441-2138
US

IV. Provider business mailing address

PO BOX 8587
DEERFIELD BEACH FL
33443-8587
US

V. Phone/Fax

Practice location:
  • Phone: 954-570-7699
  • Fax: 954-570-7698
Mailing address:
  • Phone: 954-570-7699
  • Fax: 954-570-7698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License NumberCH7618
License Number StateFL

VIII. Authorized Official

Name: DR. BRIAN PATRICK HAGGERTY
Title or Position: PRESIDENT
Credential: DC
Phone: 954-570-7699