=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497242192
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIAN G. HACKLEMAN, D.C., L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2018
-----------------------------------------------------
Last Update Date | 12/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 341 S SPRINGFIELD AVE
-----------------------------------------------------
City | BOLIVAR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65613-2040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-326-3527
-----------------------------------------------------
Fax | 417-326-3529
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 341 S SPRINGFIELD AVE
-----------------------------------------------------
City | BOLIVAR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65613-2040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-326-3527
-----------------------------------------------------
Fax | 417-326-3529
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRIAN GEORGE HACKLEMAN
-----------------------------------------------------
Credential | DOCTOR OF CHIROPRACT
-----------------------------------------------------
Telephone | 417-326-3527
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------