Provider Demographics
NPI:1477071686
Name:HAKANSON, DAVID TODD SR (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TODD
Last Name:HAKANSON
Suffix:SR
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 1:5401 W RANCHES LOOP RD
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-8400
Mailing Address - Country:US
Mailing Address - Phone:636-432-8771
Mailing Address - Fax:
Practice Address - Street 1:4444 S 700 E STE 102
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84107-3075
Practice Address - Country:US
Practice Address - Phone:636-432-8771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017031983111N00000X
UT10768566-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor