MEDICARE: BROCK S FREAR DC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1093282816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROCK S FREAR DC PLLC

Provider Business Mailing Address
First Line	:	11621 S CLEVELAND AVE STE 80
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2866
Country	:	US
Telephone Number	:	239-690-7794
Fax Number	:

Provider Business Practice Location Address
First Line	:	11621 S CLEVELAND AVE STE 80
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2866
Country	:	US
Telephone Number	:	239-690-7794
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BROCK S FREAR
Credential	:	DC
Telephone Number	:	239-690-7794

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	10/30/2018

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