Provider Demographics
NPI:1740374669
Name:BROCK, DONALD PATRICK (DC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:PATRICK
Last Name:BROCK
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 1:505 MASTER ST
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701
Mailing Address - Country:US
Mailing Address - Phone:606-528-8659
Mailing Address - Fax:606-528-8639
Practice Address - Street 1:505 MASTER ST
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701
Practice Address - Country:US
Practice Address - Phone:606-528-8659
Practice Address - Fax:606-528-8639
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1171395OtherCHA
KY85036630Medicaid
000000275308OtherANTHEM BCBS
0957401Medicare ID - Type Unspecified
KY85036630Medicaid