Provider Demographics
NPI:1811552508
Name:BLOCH, JACOB NORBERT (DC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:NORBERT
Last Name:BLOCH
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 1:344 MCDONALD ST
Mailing Address - Street 2:
Mailing Address - City:OCONTO
Mailing Address - State:WI
Mailing Address - Zip Code:54153-1152
Mailing Address - Country:US
Mailing Address - Phone:920-834-2888
Mailing Address - Fax:
Practice Address - Street 1:344 MCDONALD ST
Practice Address - Street 2:
Practice Address - City:OCONTO
Practice Address - State:WI
Practice Address - Zip Code:54153-1152
Practice Address - Country:US
Practice Address - Phone:920-834-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5458-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor