Provider Demographics
NPI:1427150671
Name:SCHROCK, KIRK D (DC)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:D
Last Name:SCHROCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 W PATRIOT ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-1529
Mailing Address - Country:US
Mailing Address - Phone:814-445-7310
Mailing Address - Fax:814-445-3409
Practice Address - Street 1:441 W PATRIOT ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1529
Practice Address - Country:US
Practice Address - Phone:814-445-7310
Practice Address - Fax:814-445-3409
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003051L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1005790Medicaid
PA141203Medicare ID - Type Unspecified
PA1005790Medicaid