Provider Demographics
NPI:1710059100
Name:BROCK CHIROPRACTIC WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:BROCK CHIROPRACTIC WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:APRILYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-698-4638
Mailing Address - Street 1:1426 AVIATION BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4002
Mailing Address - Country:US
Mailing Address - Phone:310-698-4638
Mailing Address - Fax:310-698-0978
Practice Address - Street 1:1426 AVIATION BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4002
Practice Address - Country:US
Practice Address - Phone:310-698-4638
Practice Address - Fax:310-698-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26349111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty