Provider Demographics
NPI:1417136201
Name:HACKBARTH, DAVID GARY (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GARY
Last Name:HACKBARTH
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 1:3120 SCHNEIDER AVE E
Mailing Address - Street 2:SUITE #5
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751
Mailing Address - Country:US
Mailing Address - Phone:715-232-8858
Mailing Address - Fax:715-232-8868
Practice Address - Street 1:3120 SCHNEIDER AVE E
Practice Address - Street 2:SUITE #5
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751
Practice Address - Country:US
Practice Address - Phone:715-232-8858
Practice Address - Fax:715-232-8868
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU30042Medicare UPIN