Provider Demographics
NPI:1417649120
Name:HACKETT, THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:HACKETT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:HACKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2909 WEDGEWOOD PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-1933
Mailing Address - Country:US
Mailing Address - Phone:727-657-5132
Mailing Address - Fax:
Practice Address - Street 1:10800 N MILITARY TRL STE 111
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6527
Practice Address - Country:US
Practice Address - Phone:561-775-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor