Provider Demographics
NPI:1114422995
Name:HITCHCOCK, JONATHAN FRANKLIN (DC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:FRANKLIN
Last Name:HITCHCOCK
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 1:7707 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3138
Mailing Address - Country:US
Mailing Address - Phone:502-962-2277
Mailing Address - Fax:502-962-1001
Practice Address - Street 1:2010 FLANDRO DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83202-1947
Practice Address - Country:US
Practice Address - Phone:208-351-5588
Practice Address - Fax:208-238-0603
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor