Provider Demographics
NPI:1265109185
Name:HACKWORTH, EILEEN (DC)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:HACKWORTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2858 POLECAT RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-9541
Mailing Address - Country:US
Mailing Address - Phone:707-267-4410
Mailing Address - Fax:
Practice Address - Street 1:2803 E ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4331
Practice Address - Country:US
Practice Address - Phone:707-267-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor