Provider Demographics
NPI:1730385014
Name:D PATRICK BROCK PSC
Entity type:Organization
Organization Name:D PATRICK BROCK PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-528-8659
Mailing Address - Street 1:1015 MASTER ST
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-1065
Mailing Address - Country:US
Mailing Address - Phone:606-528-8659
Mailing Address - Fax:606-528-8639
Practice Address - Street 1:1015 MASTER ST
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-1065
Practice Address - Country:US
Practice Address - Phone:606-528-8659
Practice Address - Fax:606-528-8639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0957401OtherMEDICARE INDIVIDUAL PROVIDER NUMBER
KY0957401Medicare ID - Type Unspecified