Provider Demographics
NPI:1790211522
Name:BLOCH, SHANNON (DC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BLOCH
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 1:2980 PADDOCK WOOD CT
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2541
Mailing Address - Country:US
Mailing Address - Phone:727-709-0960
Mailing Address - Fax:
Practice Address - Street 1:13300 FRANKLIN FARM RD STE B
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4096
Practice Address - Country:US
Practice Address - Phone:703-787-7463
Practice Address - Fax:703-796-0516
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor