Healthcare Provider Details

I. General information

NPI: 1548696701
Provider Name (Legal Business Name): BROCK S FREAR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8390 E KEMPER RD STE A
CINCINNATI OH
45249-1600
US

IV. Provider business mailing address

8390 E KEMPER RD STE A
CINCINNATI OH
45249-1600
US

V. Phone/Fax

Practice location:
  • Phone: 513-774-9800
  • Fax: 888-315-2865
Mailing address:
  • Phone: 513-774-9800
  • Fax: 888-850-3831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11847
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-04390
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: