Provider Demographics
NPI:1922032556
Name:BLOCK, JOHNTHAN D (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHNTHAN
Middle Name:D
Last Name:BLOCK
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 1:3431 COMMERCE PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7114
Mailing Address - Country:US
Mailing Address - Phone:330-345-1330
Mailing Address - Fax:330-264-0003
Practice Address - Street 1:3431 COMMERCE PKWY STE C
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7114
Practice Address - Country:US
Practice Address - Phone:330-345-1330
Practice Address - Fax:330-264-0003
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3561111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH251924207-00OtherBWC
OH000000377701OtherANTHEM
OH2601643Medicaid
OHBL4169161Medicare ID - Type Unspecified
OH251924207-00OtherBWC