Provider Demographics
NPI:1255992103
Name:HACKETT, ALLEN JOEL
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:JOEL
Last Name:HACKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18664 ROAD 22.6
Mailing Address - Street 2:
Mailing Address - City:DOLORES
Mailing Address - State:CO
Mailing Address - Zip Code:81323-8603
Mailing Address - Country:US
Mailing Address - Phone:970-529-6930
Mailing Address - Fax:
Practice Address - Street 1:18664 ROAD 22.6
Practice Address - Street 2:
Practice Address - City:DOLORES
Practice Address - State:CO
Practice Address - Zip Code:81323-8603
Practice Address - Country:US
Practice Address - Phone:970-529-6930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications