Provider Demographics
NPI:1487650826
Name:COCHRAN, JOHN OLIVER (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:OLIVER
Last Name:COCHRAN
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 1:4684 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-3214
Mailing Address - Country:US
Mailing Address - Phone:610-391-0858
Mailing Address - Fax:610-391-0528
Practice Address - Street 1:235 SINGLETON RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526
Practice Address - Country:US
Practice Address - Phone:843-347-3444
Practice Address - Fax:843-347-1824
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004744L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA672331OtherRHINE CHIRO. GROUP ID