Provider Demographics
NPI:1528018744
Name:SCHROCK, SAMUEL LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LAWRENCE
Last Name:SCHROCK
Suffix:
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 1:5911 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-1581
Mailing Address - Country:US
Mailing Address - Phone:308-236-6499
Mailing Address - Fax:308-236-2050
Practice Address - Street 1:218 W 39TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2802
Practice Address - Country:US
Practice Address - Phone:308-236-6499
Practice Address - Fax:308-236-2050
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor