Provider Demographics
NPI:1669522041
Name:HACMAC, EDWARD ALLAN (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALLAN
Last Name:HACMAC
Suffix:
Gender:M
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:PO BOX 68612
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97268-0612
Mailing Address - Country:US
Mailing Address - Phone:503-656-8098
Mailing Address - Fax:503-656-1660
Practice Address - Street 1:13033 SE RUSK RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2107
Practice Address - Country:US
Practice Address - Phone:503-656-8098
Practice Address - Fax:503-656-1660
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR93-0953731OtherFEDERAL TAX PAYOR ID