Provider Demographics
NPI:1437242328
Name:BROCK, PAUL ARTHUR (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ARTHUR
Last Name:BROCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14151 NEWPORT AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-5174
Mailing Address - Country:US
Mailing Address - Phone:714-838-8931
Mailing Address - Fax:714-838-1114
Practice Address - Street 1:14151 NEWPORT AVE STE 102
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-5174
Practice Address - Country:US
Practice Address - Phone:714-838-8931
Practice Address - Fax:714-838-1114
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU62446Medicare UPIN
CAWDC24093AMedicare ID - Type Unspecified