Provider Demographics
NPI:1295895076
Name:JOHNSON, BROCK LESTER (DC)
Entity type:Individual
Prefix:DR
First Name:BROCK
Middle Name:LESTER
Last Name:JOHNSON
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 1:12062 VALLEY VIEW ST STE 103
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1738
Mailing Address - Country:US
Mailing Address - Phone:562-912-4225
Mailing Address - Fax:562-912-4225
Practice Address - Street 1:12062 VALLEY VIEW ST STE 103
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1738
Practice Address - Country:US
Practice Address - Phone:562-912-4225
Practice Address - Fax:562-912-4225
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor