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General NPI Number Information
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NPI Number | 1528431624
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Entity Type | Organization
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Legal Business Name | BLOCK CHIROPRACTIC & WELLNESS
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Dates
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Enumeration Date | 11/11/2015
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Last Update Date | 11/11/2015
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Provider Practice Location Address
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Address Line | 512 MAIN ST
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City | BOTTINEAU
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State | ND
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Zip | 58318-1203
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Country | US
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Telephone | 701-208-0910
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 6TH AVE SE
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City | RUGBY
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State | ND
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Zip | 58368-2542
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Country | US
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Telephone | 701-208-0910
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Fax |
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Authorized Official
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Title or Position | DR.
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Name | DR. NICHOLE BLOCK
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Credential | D.C.
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Telephone | 701-208-0910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 992
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License Number State | ND
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