MEDICARE: DR. DANIEL P. HOCKSTRA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104556380	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	182270	OTHER	VA	ANTHEM BC/BS
2	196437	OTHER	VA	ANTHEM BC/BS

General Provider Information

NPI Number	:	1912996554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL P. HOCKSTRA D.C.

Provider Business Mailing Address
First Line	:	1300 VINCENT PLACE
Second Line	:
City	:	MCLEAN
State	:	VA
Zip	:	22101
Country	:	US
Telephone Number	:	703-760-4646
Fax Number	:	703-760-4644

Provider Business Practice Location Address
First Line	:	1300 VINCENT PLACE
Second Line	:
City	:	MCLEAN
State	:	VA
Zip	:	22101
Country	:	US
Telephone Number	:	703-760-4646
Fax Number	:	703-760-4644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	03/03/2014

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