MEDICARE: PAUL T. HACKETT D.C., P.C.

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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01632440	OTHER	IL	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1841492808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL T. HACKETT D.C., P.C.

Provider Business Mailing Address
First Line	:	3835 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3217
Country	:	US
Telephone Number	:	773-296-2225
Fax Number	:	773-296-0731

Provider Business Practice Location Address
First Line	:	3835 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3217
Country	:	US
Telephone Number	:	773-296-2225
Fax Number	:	773-296-0731

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAUL T HACKETT
Credential	:	D.C.
Telephone Number	:	773-296-2225

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	08/22/2020

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