Healthcare Provider Details

I. General information

NPI: 1225660590
Provider Name (Legal Business Name): FLOCK CHIROPRACTIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 BIDDLE RD STE #D
MEDFORD OR
97504-4691
US

IV. Provider business mailing address

1550 BIDDLE RD STE #D
MEDFORD OR
97504-4691
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-9650
  • Fax: 541-779-5315
Mailing address:
  • Phone: 541-779-9650
  • Fax: 541-779-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: GAIL Y FLOCK
Title or Position: PRESIDENT
Credential: D.C.
Phone: 541-779-9650