Provider Demographics
NPI:1821364464
Name:W G HANCOCK DC PC
Entity Type:Organization
Organization Name:W G HANCOCK DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:734-429-9459
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-0305
Mailing Address - Country:US
Mailing Address - Phone:734-429-9459
Mailing Address - Fax:734-429-5421
Practice Address - Street 1:7330 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9197
Practice Address - Country:US
Practice Address - Phone:734-429-9459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0H15019Medicare PIN
MIT33634Medicare UPIN