MEDICARE: SARAH A BROCK L.AC.

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
1	171100000X	Acupuncturist	AC01208	TX

General Provider Information

NPI Number	:	1487998571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH A BROCK L.AC.

Provider Business Mailing Address
First Line	:	6045 BAKER LN
Second Line	:
City	:	ALVARADO
State	:	TX
Zip	:	76009-5919
Country	:	US
Telephone Number	:	817-556-1764
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 8TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1352
Country	:	US
Telephone Number	:	817-556-1764
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	07/08/2016

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