Provider Demographics
NPI:1487859419
Name:BOCK, SUSANNE T (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:T
Last Name:BOCK
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 1:10370 KING WAY
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949
Mailing Address - Country:US
Mailing Address - Phone:530-272-3557
Mailing Address - Fax:
Practice Address - Street 1:10370 KING WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949
Practice Address - Country:US
Practice Address - Phone:530-272-3557
Practice Address - Fax:530-272-3557
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0225990Medicare ID - Type Unspecified