Haycock Chiropractic PC

Primary specialty

ChiropractorTaxonomy code 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

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jason Dale Haycock, DCNPI 1841271517

Title

President

Phone

(208) 855-2688

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jason D Haycock, D.C

  • Chiropractor
  • Meridian, ID
  • NPI 1841271517
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073689618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1773 S MILLENIUM WAY",
            "city": "MARIDIAN",
            "state": "ID",
            "postal_code": "836421511",
            "telephone_number": "208-855-2688",
            "fax_number": "208-855-2689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1773 S MILLENIUM WAY",
            "city": "MARIDIAN",
            "state": "ID",
            "postal_code": "836421511",
            "telephone_number": "208-855-2688",
            "fax_number": "208-855-2689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAYCOCK CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HAYCOCK",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-855-2688",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.