Healthcare Provider Details

I. General information

NPI: 1366531808
Provider Name (Legal Business Name): JAROD R HAGGARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 ANDERSON ST
BELTON SC
29627-2414
US

IV. Provider business mailing address

PO BOX 417
BELTON SC
29627-0417
US

V. Phone/Fax

Practice location:
  • Phone: 864-338-4744
  • Fax: 864-338-4745
Mailing address:
  • Phone: 864-338-4744
  • Fax: 864-338-4745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2791
License Number StateSC

VIII. Authorized Official

Name: MRS. THERESA S BUCHANAN
Title or Position: ADMIN. ASSISTANT
Credential:
Phone: 864-338-4744