Provider Demographics
NPI:1629008784
Name:HACK, DALLAS CHRISTIAN (MD, MPH, CPE)
Entity Type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:CHRISTIAN
Last Name:HACK
Suffix:
Gender:M
Credentials:MD, MPH, CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 PEACH TREE ST
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-6054
Mailing Address - Country:US
Mailing Address - Phone:304-839-2690
Mailing Address - Fax:
Practice Address - Street 1:1517 PEACH TREE ST
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862
Practice Address - Country:US
Practice Address - Phone:304-839-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN317602083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine