Provider Demographics
NPI:1568438364
Name:HISCOCKS, DONALD ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ROBERT
Last Name:HISCOCKS
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 1:1529 S MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5617
Mailing Address - Country:US
Mailing Address - Phone:641-423-5588
Mailing Address - Fax:
Practice Address - Street 1:1529 S MONROE AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-5617
Practice Address - Country:US
Practice Address - Phone:641-423-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0270124Medicaid
IA16280Medicare ID - Type Unspecified
IAU19981Medicare UPIN