Provider Demographics
NPI:1245353614
Name:HAWKINS, CORY SCOT (DC)
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:SCOT
Last Name:HAWKINS
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 1:8474 W SUN DISK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-2509
Mailing Address - Country:US
Mailing Address - Phone:208-853-2801
Mailing Address - Fax:
Practice Address - Street 1:7750 CRESTWOOD DR
Practice Address - Street 2:STE 1
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-3000
Practice Address - Country:US
Practice Address - Phone:208-376-5433
Practice Address - Fax:208-376-5636
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC7382OtherBLUE CROSS
ID000010021263OtherBLUE SHIELD
ID1673100Medicare ID - Type Unspecified
IDU48972Medicare UPIN