Provider Demographics
NPI:1851810394
Name:DAVID T HAKANSON DC PLLC
Entity Type:Organization
Organization Name:DAVID T HAKANSON DC PLLC
Other - Org Name:TBC CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:HAKANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-432-8771
Mailing Address - Street 1:5401 W RANCHES LOOP RD
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-8400
Mailing Address - Country:US
Mailing Address - Phone:636-432-8771
Mailing Address - Fax:
Practice Address - Street 1:4444 S 700 E STE 102
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84107-3075
Practice Address - Country:US
Practice Address - Phone:636-432-8771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017031983111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty