Basic Information
| Provider Information | |||||||||
| NPI: | 1982889473 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SCP CHIROPRACTIC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4767 N 20TH ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850164706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026314500 | ||||||||
| FaxNumber: | 6026314427 | ||||||||
| Practice Location | |||||||||
| Address1: | 4767 N 20TH ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850164706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026314500 | ||||||||
| FaxNumber: | 6026314427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2008 | ||||||||
| LastUpdateDate: | 03/17/2017 | ||||||||
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| AuthorizedOfficialLastName: | HAGGARD | ||||||||
| AuthorizedOfficialFirstName: | JOSHUA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6026314500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NR0400X | 5638 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Rehabilitation |
No ID Information.