Provider Demographics
NPI:1659346476
Name:HAAKENSON, JAMES ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:HAAKENSON
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 1:619 8TH ST S
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6701
Mailing Address - Country:US
Mailing Address - Phone:239-919-3557
Mailing Address - Fax:239-919-3560
Practice Address - Street 1:619 8TH ST S
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6701
Practice Address - Country:US
Practice Address - Phone:239-919-3557
Practice Address - Fax:239-919-3560
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4079111N00000X
FLCH12153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38964900Medicaid
WI000135726Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
WI38964900Medicaid