Provider Demographics
NPI:1124128970
Name:HANCOCK, KENNETH DAVID (DC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:DAVID
Last Name:HANCOCK
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 1:1321 KING AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-1440
Mailing Address - Country:US
Mailing Address - Phone:412-361-3995
Mailing Address - Fax:
Practice Address - Street 1:5713 CENTRE AVE.
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3707
Practice Address - Country:US
Practice Address - Phone:412-362-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002738L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT29403Medicare UPIN