Provider Demographics
NPI: | 1467450189 |
---|---|
Name: | HANCOCK, CHRISTI MICHELLE (DC) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | CHRISTI |
Middle Name: | MICHELLE |
Last Name: | HANCOCK |
Suffix: | |
Gender: | F |
Credentials: | DC |
Other - Prefix: | DR |
Other - First Name: | CHRISTI |
Other - Middle Name: | MICHELLE |
Other - Last Name: | RALPH |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | DC |
Mailing Address - Street 1: | 4203 E US HIGHWAY 54 |
Mailing Address - Street 2: | |
Mailing Address - City: | LINN CREEK |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 65052-1745 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 573-346-3777 |
Mailing Address - Fax: | 573-346-3891 |
Practice Address - Street 1: | 4203 E US HIGHWAY 54 |
Practice Address - Street 2: | |
Practice Address - City: | LINN CREEK |
Practice Address - State: | MO |
Practice Address - Zip Code: | 65052-1745 |
Practice Address - Country: | US |
Practice Address - Phone: | 573-346-3777 |
Practice Address - Fax: | 573-346-3891 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-07-07 |
Last Update Date: | 2011-08-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MO | 2005001318 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MO | 1194998450 | Other | GROUP NPI |
MO | 2005001318 | Other | LICENSE # |
MO | 000015705 | Medicare UPIN | |
MO | V04749 | Medicare UPIN | |
MO | 258005705 | Medicare UPIN |