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NPI Code Detail

MEDICARE: KENNETH ROBERT HAYCOCK D.C.

MEDICARE:   KENNETH ROBERT HAYCOCK  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
1111N00000XChiropractor3515OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2Q044763OTHEROHHOMETOWN
33515OTHEROHOSCB
47509586OTHEROHAETNA
5000000491984OTHEROHANTHEM BC/BS

General Provider Information

NPI Number : 1972526432
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH ROBERT HAYCOCK D.C.
Provider Business Mailing Address
First Line : 276 FEDERAL AVE NW
Second Line :
City : MASSILLON
State : OH
Zip : 44647-5469
Country : US
Telephone Number : 330-833-2085
Fax Number : 330-833-2067
Provider Business Practice Location Address
First Line : 276 FEDERAL AVE NW
Second Line :
City : MASSILLON
State : OH
Zip : 44647-5469
Country : US
Telephone Number : 330-833-2085
Fax Number : 330-833-2067
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 05/07/2009

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Directions to “ KENNETH ROBERT HAYCOCK D.C.” Practice Location

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