Provider Demographics
NPI:1093445835
Name:BROCKMAN, BRITTANY SAMANTHA (DC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:SAMANTHA
Last Name:BROCKMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30485 SW BOONES FERRY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7845
Mailing Address - Country:US
Mailing Address - Phone:503-628-9082
Mailing Address - Fax:
Practice Address - Street 1:30485 SW BOONES FERRY RD STE 104
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7845
Practice Address - Country:US
Practice Address - Phone:503-628-9082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor