Provider Demographics
NPI:1588732051
Name:HACKNEY, GREGORY TED (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:TED
Last Name:HACKNEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:GREGORY
Other - Middle Name:TED
Other - Last Name:HACKNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:153 WEDDINGTON BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3204
Mailing Address - Country:US
Mailing Address - Phone:606-432-2225
Mailing Address - Fax:606-432-0966
Practice Address - Street 1:153 WEDDINGTON BRANCH RD
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3204
Practice Address - Country:US
Practice Address - Phone:606-432-2225
Practice Address - Fax:606-432-0966
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1202309OtherCHA
KY602011100OtherACS
KY5550494OtherCCN
KY85002590Medicaid
KY000000270007OtherANTHEM BC BS
KY2180641OtherFIRST HEALTH
KY000000270007OtherANTHEM BC BS
KY0712602Medicare PIN