Provider Demographics
NPI:1760492243
Name:HANCOCK CHIROPRACTIC INC
Entity Type:Organization
Organization Name:HANCOCK CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-710-8832
Mailing Address - Street 1:4375 W HANCOCK RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-5532
Mailing Address - Country:US
Mailing Address - Phone:928-710-8832
Mailing Address - Fax:928-445-5617
Practice Address - Street 1:805 WHIPPLE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1617
Practice Address - Country:US
Practice Address - Phone:928-445-5607
Practice Address - Fax:928-445-5617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1194725846OtherINDIVIDUAL NPI#
AZ1194725846OtherINDIVIDUAL NPI#
AZ73818Medicare ID - Type UnspecifiedGROUP # PRESCOTT
AZT41691Medicare UPIN