Provider Demographics
NPI:1144229956
Name:HAKEN, LONNIE ROGER (DC)
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:ROGER
Last Name:HAKEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-2442
Mailing Address - Country:US
Mailing Address - Phone:507-376-5152
Mailing Address - Fax:
Practice Address - Street 1:1400 3RD AVE
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2442
Practice Address - Country:US
Practice Address - Phone:507-376-5152
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T65578Medicare UPIN