Provider Demographics
NPI:1912996554
Name:HOCKSTRA, DANIEL P (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
Last Name:HOCKSTRA
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 1:1300 VINCENT PLACE
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101
Mailing Address - Country:US
Mailing Address - Phone:703-760-4646
Mailing Address - Fax:703-760-4644
Practice Address - Street 1:1300 VINCENT PLACE
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101
Practice Address - Country:US
Practice Address - Phone:703-760-4646
Practice Address - Fax:703-760-4644
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA182270OtherANTHEM BC/BS
VA196437OtherANTHEM BC/BS