Healthcare Provider Details

I. General information

NPI: 1457025074
Provider Name (Legal Business Name): BROCK MICHAEL HULL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 BOARDMAN CANFIELD RD # 1B
BOARDMAN OH
44512-4380
US

IV. Provider business mailing address

68 WOODVIEW AVE
YOUNGSTOWN OH
44512-4645
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-9095
  • Fax:
Mailing address:
  • Phone: 330-402-3339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number05101
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: