Provider Demographics
NPI:1750500864
Name:BLOCK, DEBRA M (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:M
Last Name:BLOCK
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 1:3919 NATIONAL DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1105
Mailing Address - Country:US
Mailing Address - Phone:301-476-7575
Mailing Address - Fax:301-476-7730
Practice Address - Street 1:3919 NATIONAL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1105
Practice Address - Country:US
Practice Address - Phone:301-476-7575
Practice Address - Fax:301-476-7730
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02149111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01419Medicaid
MD41519201OtherBCBS RENDERING #
MD41519201OtherBCBS RENDERING #
MDKAE9Medicare UPIN
MDG01419Medicaid