MEDICARE: DR. ROBERT COURT BOCK D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH 8882	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	89867	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1003985052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT COURT BOCK D.C.

Provider Business Mailing Address
First Line	:	3206 DR MARTIN LUTHER KING JR ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-1202
Country	:	US
Telephone Number	:	727-828-0838
Fax Number	:

Provider Business Practice Location Address
First Line	:	3206 DR MARTIN LUTHER KING JR ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-1202
Country	:	US
Telephone Number	:	727-828-0838
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	08/31/2009

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