Provider Demographics
NPI:1033123443
Name:HANDCOCK, KEVIN BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BRUCE
Last Name:HANDCOCK
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 1:1713 S MAYS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6738
Mailing Address - Country:US
Mailing Address - Phone:512-310-2747
Mailing Address - Fax:512-310-2759
Practice Address - Street 1:1713 S MAYS ST
Practice Address - Street 2:SUITE A
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6738
Practice Address - Country:US
Practice Address - Phone:512-310-2747
Practice Address - Fax:512-310-2759
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F22456OtherMEDICARE INDIVIDUAL PTAN
TX106126600OtherDEPT. OF LABOR
TX1164168OtherAETNA
TX1164168OtherAETNA