Provider Demographics
NPI:1336244599
Name:BOCK, NICOLE R (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:R
Last Name:BOCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12205 COUNTY LINE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7719
Mailing Address - Country:US
Mailing Address - Phone:256-461-7775
Mailing Address - Fax:256-461-7756
Practice Address - Street 1:12205 COUNTY LINE RD
Practice Address - Street 2:SUITE D
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-7719
Practice Address - Country:US
Practice Address - Phone:256-461-7775
Practice Address - Fax:256-461-7756
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51537054OtherBLUE CROSS PROVIDER NUMBER
AL51537054OtherBLUE CROSS PROVIDER NUMBER
ALV11105Medicare UPIN