Healthcare Provider Details

I. General information

NPI: 1245558352
Provider Name (Legal Business Name): CHRISTOPHER CHARLES BORCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 EYE STREET, NW
WASHINGTON DC
20037
US

IV. Provider business mailing address

5500 WISSAHICKON AVE APARTMENT M808A
PHILADELPHIA PA
19144-5653
US

V. Phone/Fax

Practice location:
  • Phone: 202-994-3893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: