Individual
DR. JOHNATHAN ROBERT HAGGERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
208 COLUMBUS ST, HICKSVILLE, OH 43526-1250
(419) 542-5669
Mailing address
208 N COLUMBUS, HICKSVILLE, OH 43526-7674
(419) 542-5669
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3905
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2853112
—
OH
01
—
4243631
MEDICARE PTAN
OH
Enumeration date
06/23/2008
Last updated
02/25/2011
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