Provider Demographics
NPI:1548272438
Name:HANCOCK, JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:HANCOCK
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 1:502 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-2326
Mailing Address - Country:US
Mailing Address - Phone:217-466-1150
Mailing Address - Fax:217-465-9113
Practice Address - Street 1:502 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-2326
Practice Address - Country:US
Practice Address - Phone:217-466-1150
Practice Address - Fax:217-465-9113
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2382006OtherBLUE CROSS BLUE SHIELD
IL483650Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER