Healthcare Provider Details

I. General information

NPI: 1114422995
Provider Name (Legal Business Name): JONATHAN FRANKLIN HITCHCOCK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 FLANDRO DR
POCATELLO ID
83202-1947
US

IV. Provider business mailing address

7707 PRESTON HWY
LOUISVILLE KY
40219-3138
US

V. Phone/Fax

Practice location:
  • Phone: 208-351-5588
  • Fax: 208-238-0603
Mailing address:
  • Phone: 502-962-2277
  • Fax: 502-962-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5571
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: