Healthcare Provider Details

I. General information

NPI: 1114486388
Provider Name (Legal Business Name): HITCHCOCK CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2019
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

2010 FLANDRO DR
POCATELLO ID
83202-1947
US

V. Phone/Fax

Practice location:
  • Phone: 208-351-5588
  • Fax: 208-238-0603
Mailing address:
  • Phone: 208-351-5588
  • Fax: 208-238-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN FRANKLIN HITCHCOCK
Title or Position: OWNER/ DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 208-351-5588