Basic Information
| Provider Information | |||||||||
| NPI: | 1720069727 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAGGARD | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | SHAW | ||||||||
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| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26062 N 71ST LN | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853837319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238778518 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4767 N 20TH ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850164706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026314500 | ||||||||
| FaxNumber: | 6026314427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 10/01/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 5638 | AZ | Y | Chiropractic Providers | Chiropractor |
No ID Information.