Healthcare Provider Details

I. General information

NPI: 1891991089
Provider Name (Legal Business Name): STEVEN MICHAEL COCKS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 11/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N DUPONT CIR UNIT 322
PHOENIX AZ
85034-1845
US

IV. Provider business mailing address

22141 WREN WAY
LAKE FOREST CA
92630-1863
US

V. Phone/Fax

Practice location:
  • Phone: 949-292-8800
  • Fax:
Mailing address:
  • Phone: 949-292-8800
  • Fax: 949-916-6659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC21923
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: