Provider Demographics
NPI:1174682454
Name:HACKBART, DARYL LEE (DC)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:LEE
Last Name:HACKBART
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 744
Mailing Address - Street 2:508 1ST STREET
Mailing Address - City:MILFORD
Mailing Address - State:NE
Mailing Address - Zip Code:68405-0744
Mailing Address - Country:US
Mailing Address - Phone:402-671-3100
Mailing Address - Fax:402-671-3100
Practice Address - Street 1:508 1ST STREET
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NE
Practice Address - Zip Code:68405-0744
Practice Address - Country:US
Practice Address - Phone:402-671-3100
Practice Address - Fax:402-671-3100
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47082109600Medicaid
NE47082109600Medicaid