Provider Demographics
NPI:1184736837
Name:SCHROCK, DANIEL MARTIN (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MARTIN
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 1:302 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-1860
Mailing Address - Country:US
Mailing Address - Phone:615-740-5678
Mailing Address - Fax:615-740-5679
Practice Address - Street 1:302 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1860
Practice Address - Country:US
Practice Address - Phone:615-740-5678
Practice Address - Fax:615-740-5679
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001257A111N00000X
TNDC0000002225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100414770AMedicaid
IN234000Medicare ID - Type Unspecified
INU19413Medicare UPIN
IN100414770AMedicaid