Provider Demographics
NPI:1457829608
Name:SCHROCK, ERIC KEN (MSTOM, LAC, DIPL OM)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:KEN
Last Name:SCHROCK
Suffix:
Gender:M
Credentials:MSTOM, LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 N MELVINA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1036
Mailing Address - Country:US
Mailing Address - Phone:773-504-3979
Mailing Address - Fax:
Practice Address - Street 1:1741 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3216
Practice Address - Country:US
Practice Address - Phone:773-504-3979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001352171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL198.001352OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION