Provider Demographics
NPI:1356912158
Name:HANOCK, COLIN
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:HANOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 HIBISCUS WAY APT 220
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2397
Mailing Address - Country:US
Mailing Address - Phone:818-312-8804
Mailing Address - Fax:
Practice Address - Street 1:417B S TAYLOR AVE APT 3A
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4342
Practice Address - Country:US
Practice Address - Phone:818-312-8804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No286500000XHospitalsMilitary Hospital