Individual
GEORGE BRADLEY KLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3200 GRAND AVE, DES MOINES, IA 50312-4104
(515) 271-1722
(515) 271-1697
Mailing address
3200 GRAND AVE, DES MOINES, IA 50312-4104
(515) 271-1722
(515) 271-1697
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
1890
AZ
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
1998
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104810001
—
IA
01
—
AZ0064860
BCBS OF ARIZONA
AZ
Enumeration date
09/07/2005
Last updated
05/23/2012
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