Provider Demographics
NPI:1427147305
Name:BORAH, BROCK ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:BROCK
Middle Name:ALLEN
Last Name:BORAH
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:PO BOX 3691
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91508-3691
Mailing Address - Country:US
Mailing Address - Phone:818-843-3333
Mailing Address - Fax:818-396-1512
Practice Address - Street 1:1620 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-2915
Practice Address - Country:US
Practice Address - Phone:818-843-3333
Practice Address - Fax:818-396-1512
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 13461111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation