Healthcare Provider Details

I. General information

NPI: 1114786928
Provider Name (Legal Business Name): BROCK INTEGRATIVE HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11270 82ND ST E
PARRISH FL
34219-2705
US

IV. Provider business mailing address

11270 82ND ST E
PARRISH FL
34219-2705
US

V. Phone/Fax

Practice location:
  • Phone: 941-504-8983
  • Fax:
Mailing address:
  • Phone: 941-504-8983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. MELI N BROCK
Title or Position: PRES
Credential: AP, DOM, LMT
Phone: 941-504-8983