MEDICARE: JAMES HAAKENSON DC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH12153	FL

General Provider Information

NPI Number	:	1215461132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES HAAKENSON DC, LLC

Provider Business Mailing Address
First Line	:	619 8TH ST S
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-6701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 8TH ST S
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-6701
Country	:	US
Telephone Number	:	239-919-3557
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES HAAKENSON
Credential	:	DC
Telephone Number	:	239-919-3557

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	04/18/2017

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