1811125032 NPI number — CHRISTOPHER D BOCK DPM

Table of content: CHRISTOPHER D BOCK DPM (NPI 1811125032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811125032 NPI number — CHRISTOPHER D BOCK DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOCK
Provider First Name:
CHRISTOPHER
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811125032
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1145 COLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENUMCLAW
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98022-2638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-761-1285
Provider Business Mailing Address Fax Number:
360-761-1313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1145 COLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENUMCLAW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98022-2638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-761-1285
Provider Business Practice Location Address Fax Number:
360-761-1313
Provider Enumeration Date:
06/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO60103083 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: PO60103083 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0256792 . This is a "STATE L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2109216 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00784722 . This is a "RAILROAD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0252800 . This is a "STATE L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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