Healthcare Provider Details

I. General information

NPI: 1265608772
Provider Name (Legal Business Name): JOHN HORNOCKER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 LEWIS SPEEDWAY UNIT 101
SAINT AUGUSTINE FL
32084-8669
US

IV. Provider business mailing address

1510 MASON AVE
DAYTONA BEACH FL
32117
US

V. Phone/Fax

Practice location:
  • Phone: 46-791-9639
  • Fax: 904-508-0191
Mailing address:
  • Phone: 386-274-2090
  • Fax: 386-274-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9179
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: