Provider Demographics
NPI:1811585722
Name:HANCOCK, CHARLES CAVANAUGH IV (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CAVANAUGH
Last Name:HANCOCK
Suffix:IV
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 1:2900 POLO PKWY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-1423
Mailing Address - Country:US
Mailing Address - Phone:804-560-9355
Mailing Address - Fax:
Practice Address - Street 1:2900 POLO PKWY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-1423
Practice Address - Country:US
Practice Address - Phone:804-560-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor