Individual
MR. KENNETH HACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA., ATC., LAT
Contact information
Practice address
236 W READE AVE, UPLAND, IN 46989-1001
(765) 998-4780
Mailing address
236 W READE AVE, UPLAND, IN 46989-1001
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36000839A
IN
Other
Enumeration date
05/16/2014
Last updated
05/16/2014
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