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General NPI Number Information
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NPI Number | 1710108121
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Entity Type | Individual
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Provider Name | DAVID RICHARD BOCK C.AC.DIPL.OM,FABORM
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 01/08/2011
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Provider Practice Location Address
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Address Line | 888 THACKERAY TRL STE 206
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4342
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Country | US
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Telephone | 262-567-1309
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Fax |
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Provider Business Mailing Address
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Address Line | 888 THACKERAY TRL STE 206
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4342
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Country | US
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Telephone | 262-567-1309
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 263-055
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License Number State | WI
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