Provider Demographics
NPI:1336188846
Name:BLOCK, DAVID N (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:N
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 1:1108 MADISON PLZ
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5166
Mailing Address - Country:US
Mailing Address - Phone:757-436-5428
Mailing Address - Fax:757-436-5325
Practice Address - Street 1:1108 MADISON PLZ
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5166
Practice Address - Country:US
Practice Address - Phone:757-436-5428
Practice Address - Fax:757-436-5325
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU40799Medicare UPIN
VA350000947Medicare ID - Type Unspecified