Healthcare Provider Details

I. General information

NPI: 1740247543
Provider Name (Legal Business Name): SETH J. BLOCKER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 MAIN ST
MARGARETVILLE NY
12455-2821
US

IV. Provider business mailing address

PO BOX 758 1104 MAIN STREET
MARGARETVILLE NY
12455-0758
US

V. Phone/Fax

Practice location:
  • Phone: 845-586-4694
  • Fax: 845-586-1153
Mailing address:
  • Phone: 845-586-4694
  • Fax: 845-586-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX8847-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: