Provider Demographics
NPI:1609090034
Name:HOOPINSOCKER INCORPORATED
Entity Type:Organization
Organization Name:HOOPINSOCKER INCORPORATED
Other - Org Name:HOOPINSOCKER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:DEVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-290-3263
Mailing Address - Street 1:3903 JILES ROAD NE
Mailing Address - Street 2:BLDG 100 SUITE 101
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144
Mailing Address - Country:US
Mailing Address - Phone:678-290-3263
Mailing Address - Fax:678-290-2859
Practice Address - Street 1:3903 JILES ROAD NE
Practice Address - Street 2:BLDG 100 SUITE 101
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144
Practice Address - Country:US
Practice Address - Phone:678-290-3263
Practice Address - Fax:678-290-2859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA007932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
35ZCHFZMedicare ID - Type Unspecified
GAU94413Medicare UPIN