Provider Demographics
NPI:1891118782
Name:BROCK, HOPE (LAC)
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:
Last Name:BROCK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 MICHIGAN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-1648
Mailing Address - Country:US
Mailing Address - Phone:715-213-7773
Mailing Address - Fax:
Practice Address - Street 1:1336 MICHIGAN ST STE A
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1648
Practice Address - Country:US
Practice Address - Phone:715-213-7773
Practice Address - Fax:888-218-7024
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI816-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist