=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619166766
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HACKETT CHIROPRACTIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2007
-----------------------------------------------------
Last Update Date | 08/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6215 LEE HWY SUITE B
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37421-2916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-305-1819
-----------------------------------------------------
Fax | 423-305-1820
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6215 LEE HWY SUITE B
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37421-2916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-305-1819
-----------------------------------------------------
Fax | 423-305-1820
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SINGLE MEMBER
-----------------------------------------------------
Name | DR. HANNAH HACKETT
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 423-290-9097
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3283
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------