Provider Demographics
NPI:1386720746
Name:SACKETT, CHAD W (DC)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:W
Last Name:SACKETT
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 1:1310 BALTIMORE STREET
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331
Mailing Address - Country:US
Mailing Address - Phone:717-633-9500
Mailing Address - Fax:717-633-5739
Practice Address - Street 1:1310 BALTIMORE STREET
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331
Practice Address - Country:US
Practice Address - Phone:717-633-9500
Practice Address - Fax:717-633-5739
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005914L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASA40472OtherBLUE SHIELD
53316902OtherCAREFIRST BCBS
DCT6090001OtherCAREFIRST BCBS
PASA1301708OtherBLUE SHIELD
U51973Medicare UPIN
PA091442Medicare ID - Type Unspecified