Provider Demographics
NPI:1891507372
Name:BROCK, PEYTON DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:PEYTON
Middle Name:DAVID
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 1:4220 A ST SE STE 103
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-8620
Mailing Address - Country:US
Mailing Address - Phone:253-833-4800
Mailing Address - Fax:
Practice Address - Street 1:4220 A ST SE STE 103
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-8620
Practice Address - Country:US
Practice Address - Phone:253-833-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61605292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor