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NPI Code Detail

MEDICARE: DR. BROCK LESTER JOHNSON D.C.

MEDICARE: DR. BROCK LESTER JOHNSON D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor30300CA

General Provider Information

NPI Number : 1295895076
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BROCK LESTER JOHNSON D.C.
Provider Business Mailing Address
First Line : 12062 VALLEY VIEW ST STE 103
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92845-1738
Country : US
Telephone Number : 562-912-4225
Fax Number : 562-912-4225
Provider Business Practice Location Address
First Line : 12062 VALLEY VIEW ST STE 103
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92845-1738
Country : US
Telephone Number : 562-912-4225
Fax Number : 562-912-4225
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2006
Last Update Date : 07/27/2023

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