Provider Demographics
NPI:1417162421
Name:HOCKENBERRY, JASON ALBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALBERT
Last Name:HOCKENBERRY
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 1:795 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MC VEYTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17051-8920
Mailing Address - Country:US
Mailing Address - Phone:814-542-3127
Mailing Address - Fax:814-542-3128
Practice Address - Street 1:14330 CROGHAN PIKE
Practice Address - Street 2:
Practice Address - City:MOUNT UNION
Practice Address - State:PA
Practice Address - Zip Code:17066-8838
Practice Address - Country:US
Practice Address - Phone:814-542-3127
Practice Address - Fax:814-542-3128
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007475L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA478783OtherBLUE CROSS PROVIDER NUMBE
PA027937Medicare ID - Type Unspecified