Individual
MR. RYAN HACKING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTRL
Contact information
Practice address
2314 PEPPERCORN RD, LEHI, UT 84043-4772
(801) 660-7613
(801) 407-6577
Mailing address
2314 PEPPERCORN RD, LEHI, UT 84043-4772
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
4971361-4201
UT
Other
Enumeration date
02/20/2007
Last updated
07/08/2007
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