Provider Demographics
NPI:1578273140
Name:HENCOCK CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HENCOCK CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORENIL
Authorized Official - Middle Name:HENCOCK
Authorized Official - Last Name:BONCEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:470-503-1551
Mailing Address - Street 1:4542 WARRIOR TRL SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4152
Mailing Address - Country:US
Mailing Address - Phone:470-503-1551
Mailing Address - Fax:
Practice Address - Street 1:5520 LILBURN STONE MOUNTAIN RD STE E1
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-2876
Practice Address - Country:US
Practice Address - Phone:470-870-8680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center