Provider Demographics
NPI:1538103445
Name:HAWK, CHADWICK W (DC)
Entity Type:Individual
Prefix:DR
First Name:CHADWICK
Middle Name:W
Last Name:HAWK
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 1:4707 COLLEGE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1679
Mailing Address - Country:US
Mailing Address - Phone:913-334-7340
Mailing Address - Fax:
Practice Address - Street 1:4707 COLLEGE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211
Practice Address - Country:US
Practice Address - Phone:913-334-7340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555745111N00000X
KS01-05900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350001068Medicare ID - Type Unspecified