MEDICARE: BROCK MICHAEL STRATTON D.C.

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	12070	TX

General Provider Information

NPI Number	:	1386906634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROCK MICHAEL STRATTON D.C.

Provider Business Mailing Address
First Line	:	PO BOX 593043
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-0202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E SONTERRA BLVD
Second Line	:	SUITE 410
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3971
Country	:	US
Telephone Number	:	210-837-8244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/12/2012

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