Brian G. Hackleman, D.C., L.L.C.
Organization Active NPI Chiropractor · Bolivar, MO
NPI 1497242192 · NPPES record last updated Dec 12, 2023
Key facts
- NPI
- 1497242192
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- BRIAN G. HACKLEMAN, D.C., L.L.C.
- Practice address
- 341 S Springfield Ave
Bolivar, MO 65613-2040 - Phone
- (417) 326-3527
- Fax
- (417) 326-3529
- NPI assigned
- Apr 18, 2018
- Organization subpart
- No
Authorized official
- Name
- Dr. Brian George Hackleman, DOCTOR OF CHIROPRACT
- Title
- Owner
- Phone
- (417) 326-3527
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180509001037 | MO | Part B Supplier - Clinic/Group Practice | 2062776537 |
Receives reassigned benefits from 1 practitioner Practice locations: Bolivar, MO |
National Provider Directory
Locations
341 S Springfield Ave
Bolivar, MO 65613
Phone (417) 326-3527
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | Yes | ||
| Acupuncturist |
171100000X |
Addresses
Primary practice location
341 S Springfield Ave
Bolivar, MO 65613-2040
Mailing address
341 S Springfield Ave
Bolivar, MO 65613-2040
Phone (417) 326-3527
Other providers in Bolivar, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 12, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.