=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669185088
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDE THOMAS HOCKEL DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2022
-----------------------------------------------------
Last Update Date | 12/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1193 BERGEN PKWY STE F
-----------------------------------------------------
City | EVERGREEN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80439-9504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-670-8902
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3457 RINGSBY CT UNIT 322
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80216-4914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-262-3724
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHR.0008636
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------