Provider Demographics
NPI:1659343721
Name:HANCOCK, GERALDA F (DC)
Entity Type:Individual
Prefix:DR
First Name:GERALDA
Middle Name:F
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:GERALDA
Other - Middle Name:F
Other - Last Name:BAGBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:54 THE LEGENDS PKWY
Mailing Address - Street 2:SUITE 154
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-3803
Mailing Address - Country:US
Mailing Address - Phone:636-938-1010
Mailing Address - Fax:636-938-1011
Practice Address - Street 1:54 THE LEGENDS PKWY
Practice Address - Street 2:SUITE 154
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3803
Practice Address - Country:US
Practice Address - Phone:636-938-1010
Practice Address - Fax:636-938-1011
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE005209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
134817OtherHEALTHLINK
10937X001OtherBCBS
225347OtherPHCS
4326819OtherAETNA
10937X001OtherBCBS