Healthcare Provider Details

I. General information

NPI: 1508015793
Provider Name (Legal Business Name): BLOCK CHIROPRACTIC AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 NATIONAL DR STE 250
BURTONSVILLE MD
20866-1187
US

IV. Provider business mailing address

3901 NATIONAL DR STE 250
BURTONSVILLE MD
20866-1187
US

V. Phone/Fax

Practice location:
  • Phone: 301-476-7575
  • Fax: 301-476-7730
Mailing address:
  • Phone: 301-476-7575
  • Fax: 301-476-7730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS02149
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberS02149
License Number StateMD

VIII. Authorized Official

Name: DR. DEBRA M BLOCK
Title or Position: SOLE MEMBER
Credential: D.C.
Phone: 301-476-7575