Provider Demographics
NPI:1861779746
Name:BLOCH, KYLE STEVEN (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:STEVEN
Last Name:BLOCH
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 1:8224 SPRUCE ST
Mailing Address - Street 2:STE 330
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-2201
Mailing Address - Country:US
Mailing Address - Phone:703-368-8800
Mailing Address - Fax:703-368-1281
Practice Address - Street 1:8224 SPRUCE ST STE 330
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20111-2201
Practice Address - Country:US
Practice Address - Phone:703-368-8800
Practice Address - Fax:703-368-1281
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor