Provider Demographics
NPI:1003631847
Name:SCHROCK, JASON RAY
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:RAY
Last Name:SCHROCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BUFFORD ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68852-1869
Mailing Address - Country:US
Mailing Address - Phone:308-240-0465
Mailing Address - Fax:
Practice Address - Street 1:305 BUFFORD ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:NE
Practice Address - Zip Code:68852-1869
Practice Address - Country:US
Practice Address - Phone:308-240-0465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE55601-23171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications