Provider Demographics
NPI:1659417194
Name:HACKLER, MELVIN GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:GREGORY
Last Name:HACKLER
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 1:218 N WILLIAMSON AVE
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-3721
Mailing Address - Country:US
Mailing Address - Phone:928-289-2416
Mailing Address - Fax:928-289-2416
Practice Address - Street 1:218 N WILLIAMSON AVE
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-3721
Practice Address - Country:US
Practice Address - Phone:928-289-2416
Practice Address - Fax:928-289-2416
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0085170OtherBLUECROSSBLUESHIELD IDEN
AZAZ0085170OtherBLUECROSSBLUESHIELD IDEN