Healthcare Provider Details

I. General information

NPI: 1629376066
Provider Name (Legal Business Name): HACKETT CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 NILES RD
SAINT JOSEPH MI
49085-3338
US

IV. Provider business mailing address

2820 NILES RD
SAINT JOSEPH MI
49085-3338
US

V. Phone/Fax

Practice location:
  • Phone: 269-429-1982
  • Fax: 269-556-9615
Mailing address:
  • Phone: 269-429-1982
  • Fax: 269-556-9615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009792
License Number StateMI

VIII. Authorized Official

Name: DR. PATRICK MICHAEL HACKETT
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 269-429-1982