Provider Demographics
NPI:1053358291
Name:HACKLEMAN, BRIAN G (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:G
Last Name:HACKLEMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 S SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-2040
Mailing Address - Country:US
Mailing Address - Phone:417-326-3527
Mailing Address - Fax:417-326-3529
Practice Address - Street 1:341 S SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2040
Practice Address - Country:US
Practice Address - Phone:417-326-3527
Practice Address - Fax:417-326-3529
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006529171100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO188731OtherBCBS OF MO
MO000025678OtherMEDICARE PTAN
MO230073733Medicaid
MO188731OtherBCBS OF MO