Provider Demographics
NPI:1548342793
Name:HACK, JOEL Q (DC)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:Q
Last Name:HACK
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 1:10985 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3056
Mailing Address - Country:US
Mailing Address - Phone:734-427-6877
Mailing Address - Fax:
Practice Address - Street 1:10985 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3056
Practice Address - Country:US
Practice Address - Phone:734-427-6877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950Q25127OtherBLUE CROSS/BLUE SHIELD
MI0Q25127Medicare ID - Type UnspecifiedMEDICARE NUMBER