Provider Demographics
NPI:1962581801
Name:SCHWARTZ, BROCK RAY (DC)
Entity type:Individual
Prefix:DR
First Name:BROCK
Middle Name:RAY
Last Name:SCHWARTZ
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 1:2755 S LOCUST ST
Mailing Address - Street 2:SUITE117
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7126
Mailing Address - Country:US
Mailing Address - Phone:303-721-7660
Mailing Address - Fax:303-758-9447
Practice Address - Street 1:2755 S LOCUST ST
Practice Address - Street 2:SUITE 117
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7126
Practice Address - Country:US
Practice Address - Phone:303-721-7660
Practice Address - Fax:303-758-9447
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT01210Medicare UPIN
CO48853Medicare ID - Type Unspecified