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General NPI Number Information
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NPI Number | 1649022427
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Entity Type | Individual
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Provider Name | BROCK W DUDLEY DC
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Gender | Male
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Dates
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Enumeration Date | 04/03/2024
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 1011 RANCHO CONEJO BLVD
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City | THOUSAND OAKS
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State | CA
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Zip | 91320-1718
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Country | US
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Telephone | 951-595-2281
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Fax |
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Provider Business Mailing Address
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Address Line | 2857 LAS POSAS CIR
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City | SANTA ROSA VALLEY
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State | CA
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Zip | 93012-8211
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 35222
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License Number State | CA
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