Provider Demographics
NPI:1366531808
Name:JAROD R HAGGARD
Entity type:Organization
Organization Name:JAROD R HAGGARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN. ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-338-4744
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:SC
Mailing Address - Zip Code:29627-0417
Mailing Address - Country:US
Mailing Address - Phone:864-338-4744
Mailing Address - Fax:864-338-4745
Practice Address - Street 1:1404 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:SC
Practice Address - Zip Code:29627-2414
Practice Address - Country:US
Practice Address - Phone:864-338-4744
Practice Address - Fax:864-338-4745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2791Medicaid
SCSC10001479Medicare ID - Type UnspecifiedSUBMITTER ID
SC=========Medicare UPIN
SCAA01120281Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID