Provider Demographics
NPI:1629128103
Name:AYCOCK, JIMMY DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:DEAN
Last Name:AYCOCK
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 1:315 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501-3160
Mailing Address - Country:US
Mailing Address - Phone:254-773-2139
Mailing Address - Fax:254-773-2130
Practice Address - Street 1:315 N 3RD ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-3160
Practice Address - Country:US
Practice Address - Phone:254-773-2139
Practice Address - Fax:254-773-2130
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT-12014Medicare UPIN
TX600009Medicare ID - Type Unspecified