Provider Demographics
NPI:1154166973
Name:CLEMENTS, BROCK (DC)
Entity type:Individual
Prefix:MR
First Name:BROCK
Middle Name:
Last Name:CLEMENTS
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 1:1231 CABRILLO AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2867
Mailing Address - Country:US
Mailing Address - Phone:310-543-7779
Mailing Address - Fax:844-314-9911
Practice Address - Street 1:1300 S PACIFIC COAST HWY STE 201
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5003
Practice Address - Country:US
Practice Address - Phone:310-543-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC37016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor