Provider Demographics
NPI:1730377441
Name:BROCK, ANA M (DC)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:M
Last Name:BROCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:INOCENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:87 GRASSO PLZ # 194
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-3107
Mailing Address - Country:US
Mailing Address - Phone:314-246-9667
Mailing Address - Fax:
Practice Address - Street 1:2244A UNION RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125
Practice Address - Country:US
Practice Address - Phone:314-246-9667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007021504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor