MEDICARE: DR. PETER HAGGENJOS 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	3754	NC
2	111N00000X	Chiropractor	3877	OH
3	111N00000X	Chiropractor	08002378A	IN

General Provider Information

NPI Number	:	1316120454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER HAGGENJOS D.C.

Provider Business Mailing Address
First Line	:	936 HATCH ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-1529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	936 HATCH ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-1529
Country	:	US
Telephone Number	:	513-723-1190
Fax Number	:

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

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	04/14/2008

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