Provider Demographics
NPI:1063573376
Name:HADDOCK, JASON (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:HADDOCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 COX CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1535
Mailing Address - Country:US
Mailing Address - Phone:256-766-1987
Mailing Address - Fax:256-766-1924
Practice Address - Street 1:223 COX CREEK PKWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1535
Practice Address - Country:US
Practice Address - Phone:256-766-1987
Practice Address - Fax:256-766-1924
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALV00647Medicare UPIN