Provider Demographics
NPI:1568648632
Name:DR KEVIN D HANCOCK PC
Entity Type:Organization
Organization Name:DR KEVIN D HANCOCK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-271-1111
Mailing Address - Street 1:6910 N MAIN STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8845
Mailing Address - Country:US
Mailing Address - Phone:574-271-1111
Mailing Address - Fax:574-271-7532
Practice Address - Street 1:6910 N MAIN STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8845
Practice Address - Country:US
Practice Address - Phone:574-271-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200022950AMedicaid
IN168820Medicare PIN
IN200022950AMedicaid