Provider Demographics
NPI:1619649738
Name:BROCK LLC
Entity Type:Organization
Organization Name:BROCK LLC
Other - Org Name:ASCENSION CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-301-5120
Mailing Address - Street 1:31430 LAVENDER DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48173-8743
Mailing Address - Country:US
Mailing Address - Phone:734-301-5120
Mailing Address - Fax:
Practice Address - Street 1:13685 EUREKA RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1332
Practice Address - Country:US
Practice Address - Phone:734-984-3620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center