Haycock Chiropractic PC
Chiropractor in Maridian, ID. Organization (NPI-2).
NPI number1073689618
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1073689618
- Entity type
- Organization (NPI-2)
- Legal business name
- Haycock Chiropractic PC
- Organization subpart
- No
- Enumeration date
- Nov 27, 2006
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 111N00000X | Chiropractor | – | – | Yes |
Practice location
1773 S Millenium WayMaridian, ID 83642-1511
Phone 208-855-2688 · Fax 208-855-2689
Mailing address
1773 S Millenium WayMaridian, ID 83642-1511
Phone 208-855-2688 · Fax 208-855-2689
Authorized official
Jason Dale Haycock
President
2088552688
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