Provider Demographics
NPI:1508031139
Name:ELIZABETH V HACKLEMAN, D.C., P.C.
Entity Type:Organization
Organization Name:ELIZABETH V HACKLEMAN, D.C., P.C.
Other - Org Name:HACKLEMAN CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:HACKLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-228-5522
Mailing Address - Street 1:801 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-3707
Mailing Address - Country:US
Mailing Address - Phone:816-228-5522
Mailing Address - Fax:816-220-0205
Practice Address - Street 1:801 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3707
Practice Address - Country:US
Practice Address - Phone:816-228-5522
Practice Address - Fax:816-220-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1710989694OtherNPI INDIVIDUAL
MO1710989694OtherNPI INDIVIDUAL