Provider Demographics
NPI:1720125305
Name:BROCK, JOEL BRANDON (NP-C, DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:BRANDON
Last Name:BROCK
Suffix:
Gender:M
Credentials:NP-C, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2345 N HOUSTON ST APT 606
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-7633
Mailing Address - Country:US
Mailing Address - Phone:214-728-4314
Mailing Address - Fax:972-812-3030
Practice Address - Street 1:105 DECKER CT
Practice Address - Street 2:SUITE 120
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-2767
Practice Address - Country:US
Practice Address - Phone:214-771-8885
Practice Address - Fax:972-771-1648
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8026111N00000X, 111NN0400X, 111NR0400X
TX774910364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation