Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC 13461 | CA |
NPI | 1427147305 |
---|---|
Provider Name | Dr. Brock Allen Borah |
First Address | Burbank, CA 91508-3691 |
Second Address | Glendale, CA 91201-2915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 09/11/2015 |