Provider Demographics
NPI:1326237934
Name:HANCOCK, JONATHAN MICHAEL (LMP)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5574 HILLARD RD
Mailing Address - Street 2:
Mailing Address - City:EVERSON
Mailing Address - State:WA
Mailing Address - Zip Code:98247-9425
Mailing Address - Country:US
Mailing Address - Phone:360-592-4346
Mailing Address - Fax:360-685-8184
Practice Address - Street 1:2221 JAMES ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4141
Practice Address - Country:US
Practice Address - Phone:360-201-8962
Practice Address - Fax:360-685-8184
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023976174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist