Provider Demographics
NPI:1174593719
Name:HANCOCK, TANNER PATRICK (DC)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:PATRICK
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 1:1304 VILLAGE CREEK DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4472
Mailing Address - Country:US
Mailing Address - Phone:469-225-0558
Mailing Address - Fax:
Practice Address - Street 1:1304 VILLAGE CREEK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4472
Practice Address - Country:US
Practice Address - Phone:469-225-0558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y25634Medicare UPIN
KS0660088Medicare ID - Type Unspecified