Provider Demographics
NPI:1396016267
Name:NOCKERDC LLC
Entity Type:Organization
Organization Name:NOCKERDC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-274-2090
Mailing Address - Street 1:1510 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4549
Mailing Address - Country:US
Mailing Address - Phone:386-274-2090
Mailing Address - Fax:
Practice Address - Street 1:1510 MASON AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4549
Practice Address - Country:US
Practice Address - Phone:386-274-2090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty