Provider Demographics
NPI:1447371539
Name:HALLACKER, MICHAEL L (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:HALLACKER
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:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:STOCKHOLM
Mailing Address - State:NJ
Mailing Address - Zip Code:07460-0636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2764 RT 23 N
Practice Address - Street 2:
Practice Address - City:STOCKHOLM
Practice Address - State:NJ
Practice Address - Zip Code:07460
Practice Address - Country:US
Practice Address - Phone:973-697-2800
Practice Address - Fax:973-697-7606
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6798802Medicaid
NJ201082651OtherIDA
NJ833270Medicare ID - Type Unspecified