MEDICARE: DR. ROBRET HAGOOD D.C.

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	111N00000X	Chiropractor	7291	TX

General Provider Information

NPI Number	:	1073732764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBRET HAGOOD D.C.

Provider Business Mailing Address
First Line	:	2121 W PARMER LN
Second Line	:	#112
City	:	AUSTIN
State	:	TX
Zip	:	78727-4300
Country	:	US
Telephone Number	:	512-339-6635
Fax Number	:	512-339-6637

Provider Business Practice Location Address
First Line	:	2121 W PARMER LN
Second Line	:	#112
City	:	AUSTIN
State	:	TX
Zip	:	78727-4300
Country	:	US
Telephone Number	:	512-339-6635
Fax Number	:	512-339-6637

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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