Provider Demographics
NPI:1326067638
Name:ROCK, JONATHAN S IV (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:S
Last Name:ROCK
Suffix:IV
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 1:1625 SNYDER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3043
Mailing Address - Country:US
Mailing Address - Phone:215-462-7000
Mailing Address - Fax:215-462-6100
Practice Address - Street 1:1625 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3043
Practice Address - Country:US
Practice Address - Phone:215-462-7000
Practice Address - Fax:215-462-6100
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2313593000OtherIBC PROVIDER NUMBER
PA1620729OtherHIGMARK BCBS PROVIDER