Provider Demographics
NPI:1699704544
Name:RUSSELL M HOCH
Entity type:Organization
Organization Name:RUSSELL M HOCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOCH
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:570-387-1450
Mailing Address - Street 1:499 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1567
Mailing Address - Country:US
Mailing Address - Phone:570-387-1450
Mailing Address - Fax:570-387-1575
Practice Address - Street 1:499 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1567
Practice Address - Country:US
Practice Address - Phone:570-387-1450
Practice Address - Fax:570-387-1575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-2391-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty