Provider Demographics
NPI:1821623877
Name:FUNCTIONAL HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:FUNCTIONAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:HOKANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:774-696-3512
Mailing Address - Street 1:30 EXETER PL
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-2058
Mailing Address - Country:US
Mailing Address - Phone:774-696-3512
Mailing Address - Fax:772-323-0509
Practice Address - Street 1:30 EXETER PL
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2058
Practice Address - Country:US
Practice Address - Phone:774-696-3512
Practice Address - Fax:772-323-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty