Healthcare Provider Details

I. General information

NPI: 1215159017
Provider Name (Legal Business Name): KATRINA M HACKETT D.C, A.T.C, C.S.C.S,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6474 NANCY RIDGE DR
SAN DIEGO CA
92121-2248
US

IV. Provider business mailing address

3525 DEL MAR HEIGHTS RD # 319
SAN DIEGO CA
92130-2122
US

V. Phone/Fax

Practice location:
  • Phone: 858-876-2171
  • Fax: 858-876-1876
Mailing address:
  • Phone: 858-876-2171
  • Fax: 858-876-1876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number30896
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: