Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 8026 | TX |
N | 111NN0400X | Neurology | 8026 | TX |
N | 111NR0400X | Rehabilitation Chiropractor | 8026 | TX |
NPI | 1720125305 |
---|---|
Provider Name | Dr. Joel Brandon Brock |
First Address | Dallas, TX 75219-7633 |
Second Address | Irving, TX 75062-2767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 22/08/2014 |