Provider Demographics
NPI:1124178256
Name:HACKER, DAWN MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:MARIE
Last Name:HACKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:HICKS-HACKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:309 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-3203
Mailing Address - Country:US
Mailing Address - Phone:405-282-8585
Mailing Address - Fax:
Practice Address - Street 1:309 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-3203
Practice Address - Country:US
Practice Address - Phone:405-282-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK249772705Medicare PIN