Provider Demographics
NPI:1578537593
Name:LOVETT, BROCK W (DC)
Entity Type:Individual
Prefix:
First Name:BROCK
Middle Name:W
Last Name:LOVETT
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 1:2203 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1703
Mailing Address - Country:US
Mailing Address - Phone:806-358-7106
Mailing Address - Fax:806-355-0524
Practice Address - Street 1:2203 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1703
Practice Address - Country:US
Practice Address - Phone:806-358-7106
Practice Address - Fax:806-355-0524
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601071Medicare PIN
TX8F1414Medicare PIN
T14490Medicare UPIN