MEDICARE: DR. JOEL BRANDON BROCK NP-C, DC

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	8026	TX
2	111NN0400X	Neurology Chiropractor	8026	TX
3	111NR0400X	Rehabilitation Chiropractor	8026	TX
4	364SF0001X	Family Health Clinical Nurse Specialist	774910	TX

General Provider Information

NPI Number	:	1720125305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL BRANDON BROCK NP-C, DC

Provider Business Mailing Address
First Line	:	2345 N HOUSTON ST APT 606
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-7633
Country	:	US
Telephone Number	:	214-728-4314
Fax Number	:	972-812-3030

Provider Business Practice Location Address
First Line	:	105 DECKER CT
Second Line	:	SUITE 120
City	:	IRVING
State	:	TX
Zip	:	75062-2767
Country	:	US
Telephone Number	:	214-771-8885
Fax Number	:	972-771-1648

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	08/22/2014

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