Provider Demographics
NPI:1093978066
Name:DANIEL T. COCKS FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:DANIEL T. COCKS FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:COCKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-686-4660
Mailing Address - Street 1:9707 PULASKI HWY STE B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1407
Mailing Address - Country:US
Mailing Address - Phone:410-686-4660
Mailing Address - Fax:410-686-4661
Practice Address - Street 1:9707 PULASKI HWY STE B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-1407
Practice Address - Country:US
Practice Address - Phone:410-686-4660
Practice Address - Fax:410-686-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD352BDAOtherCAREFIRST BLUE CROSS BLUE SHIELD
MD141264ZCAUOtherMEDICARE GROUP MEMBER PROVIDER IDENTIFIER
MDK120OtherCARE FIRST BLUE CHOICE
MD352BDAOtherCAREFIRST BLUE CROSS BLUE SHIELD
MDV02382Medicare UPIN