Provider Demographics
NPI:1952447328
Name:HACKLER CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:HACKLER CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:HACKLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-289-2416
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0085170OtherBLUECROSSBLUESHIELD
AZAZ0085170OtherBLUECROSSBLUESHIELD