Provider Demographics
NPI:1174712400
Name:HAMMOCK, MARK J (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:HAMMOCK
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 1:959 ROSS ST
Mailing Address - Street 2:PO BOX 215
Mailing Address - City:HEFLIN
Mailing Address - State:AL
Mailing Address - Zip Code:36264-1165
Mailing Address - Country:US
Mailing Address - Phone:256-463-5555
Mailing Address - Fax:256-463-5537
Practice Address - Street 1:959 ROSS ST
Practice Address - Street 2:
Practice Address - City:HEFLIN
Practice Address - State:AL
Practice Address - Zip Code:36264-1165
Practice Address - Country:US
Practice Address - Phone:256-463-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000073441Medicare UPIN