Provider Demographics
NPI:1073400073
Name:BROCK, CALVIN D (BS)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:D
Last Name:BROCK
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 NEPTUNE DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-8008
Mailing Address - Country:US
Mailing Address - Phone:469-418-0621
Mailing Address - Fax:
Practice Address - Street 1:616 NEPTUNE DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-8008
Practice Address - Country:US
Practice Address - Phone:469-418-0621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120421225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist