MEDICARE: BROCK CHIROPRACTIC WELLNESS CENTER, INC.

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	111N00000X	Chiropractor	DC26349	CA

General Provider Information

NPI Number	:	1710059100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROCK CHIROPRACTIC WELLNESS CENTER, INC.

Provider Business Mailing Address
First Line	:	1426 AVIATION BLVD
Second Line	:	SUITE 202
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-4002
Country	:	US
Telephone Number	:	310-698-4638
Fax Number	:	310-698-0978

Provider Business Practice Location Address
First Line	:	1426 AVIATION BLVD
Second Line	:	SUITE 202
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-4002
Country	:	US
Telephone Number	:	310-698-4638
Fax Number	:	310-698-0978

Authorized Official
Title or Position	:	OWNER
Name	:	DR. APRILYN ANN STITT
Credential	:	D.C.
Telephone Number	:	310-698-4638

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	03/30/2009

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