Haycock Chiropractic PC
Organization Active NPI Chiropractor · Maridian, ID
NPI 1073689618 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1073689618
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- HAYCOCK CHIROPRACTIC PC
- Practice address
- 1773 S Millenium Way
Maridian, ID 83642-1511 - Phone
- (208) 855-2688
- Fax
- (208) 855-2689
- NPI assigned
- Nov 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Jason Dale Haycock, DC
- Title
- President
- Phone
- (208) 855-2688
Practitioners 1
-
Jason D Haycock, D.C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041018001049 | ID | Part B Supplier - Clinic/Group Practice | 6002876604 |
Receives reassigned benefits from 1 practitioner Practice locations: Meridian, ID |
National Provider Directory
Locations
9211 W Overland Rd
Boise, ID 83709
Phone (208) 377-8777
1773 S Millenium Way
Meridian, ID 83642
Phone (208) 855-2688
3175 S Meridian Rd
Ste 100
Meridian, ID 83642
Phone (208) 855-2688
1773 S Millenium Way
#120
Meridian, ID 83642
Phone (208) 855-2688
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | Yes |
Addresses
Primary practice location
1773 S Millenium Way
Maridian, ID 83642-1511
Mailing address
1773 S Millenium Way
Maridian, ID 83642-1511
Phone (208) 855-2688
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.