Provider Demographics
NPI:1659502359
Name:HACKE, DEREK A (DC)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:A
Last Name:HACKE
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 1:27314 JEFFERSON AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5602
Mailing Address - Country:US
Mailing Address - Phone:951-296-0746
Mailing Address - Fax:951-296-0746
Practice Address - Street 1:27314 JEFFERSON AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5602
Practice Address - Country:US
Practice Address - Phone:951-296-0746
Practice Address - Fax:951-296-0746
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor