Provider Demographics
NPI:1265821177
Name:BLOCK, NICHOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:
Last Name:BLOCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 20TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6441
Mailing Address - Country:US
Mailing Address - Phone:701-838-8000
Mailing Address - Fax:701-838-8444
Practice Address - Street 1:126 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-1733
Practice Address - Country:US
Practice Address - Phone:701-776-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND18476OtherMEDICAID GROUP NUMBER
NDN711351OtherMEDICARE PTAN
ND10644Medicaid
ND10644Medicaid