Provider Demographics
NPI:1407947575
Name:HACKER, ROBERT ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLEN
Last Name:HACKER
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 1:40 NEW YORK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6409
Mailing Address - Country:US
Mailing Address - Phone:865-482-7246
Mailing Address - Fax:865-482-9900
Practice Address - Street 1:40 NEW YORK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6409
Practice Address - Country:US
Practice Address - Phone:865-482-7246
Practice Address - Fax:865-482-9900
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3672535Medicare ID - Type Unspecified
TNT-74520Medicare UPIN