Provider Demographics
NPI:1174799233
Name:HOCKERSMITH, KEVIN WESLEY (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:WESLEY
Last Name:HOCKERSMITH
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 1:560 S STATE ST
Mailing Address - Street 2:SUITE J5
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6354
Mailing Address - Country:US
Mailing Address - Phone:801-229-2462
Mailing Address - Fax:
Practice Address - Street 1:560 S STATE ST
Practice Address - Street 2:SUITE J5
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6354
Practice Address - Country:US
Practice Address - Phone:801-229-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT286096-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor