Provider Demographics
NPI:1356732101
Name:SCHROCK, BRIAN A (PA)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:A
Last Name:SCHROCK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S SWEETBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:IL
Mailing Address - Zip Code:61523-2264
Mailing Address - Country:US
Mailing Address - Phone:309-274-2102
Mailing Address - Fax:
Practice Address - Street 1:525 S SWEETBRIAR DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:IL
Practice Address - Zip Code:61523-2264
Practice Address - Country:US
Practice Address - Phone:309-274-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-005406363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085.005406OtherSTATE OF IL LICENSE NUMBER