Provider Demographics
NPI:1134143829
Name:BOCK, MARCANDRE (DC, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCANDRE
Middle Name:
Last Name:BOCK
Suffix:
Gender:M
Credentials:DC, PHD
Other - Prefix:DR
Other - First Name:MARC
Other - Middle Name:
Other - Last Name:BOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, PHD
Mailing Address - Street 1:8201 NEWMAN AVE.
Mailing Address - Street 2:102
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7043
Mailing Address - Country:US
Mailing Address - Phone:714-847-5350
Mailing Address - Fax:
Practice Address - Street 1:8201 NEWMAN AVE
Practice Address - Street 2:102
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7020
Practice Address - Country:US
Practice Address - Phone:714-847-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13409103TC0700X
CADC11553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0115530OtherBLUE SHIELD CHIROPRACTOR
CAOPL134090OtherBLUE SHIELD PSYCHOLOGIST
CADC0115530OtherBLUE SHIELD CHIROPRACTOR
CADC11553Medicare PIN