Provider Demographics
NPI:1508015793
Name:BLOCK CHIROPRACTIC AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:BLOCK CHIROPRACTIC AND REHABILITATION CENTER, LLC
Other - Org Name:BLOCK WELLNESS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-476-7575
Mailing Address - Street 1:3901 NATIONAL DR STE 250
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1187
Mailing Address - Country:US
Mailing Address - Phone:301-476-7575
Mailing Address - Fax:301-476-7730
Practice Address - Street 1:3901 NATIONAL DR STE 250
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1187
Practice Address - Country:US
Practice Address - Phone:301-476-7575
Practice Address - Fax:301-476-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02149111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty