Provider Demographics
NPI:1114105319
Name:BROCKMAN, NICHOLAS ADAM (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ADAM
Last Name:BROCKMAN
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 242
Mailing Address - Street 2:
Mailing Address - City:HAWESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42348-0242
Mailing Address - Country:US
Mailing Address - Phone:270-927-1000
Mailing Address - Fax:270-927-1077
Practice Address - Street 1:135 MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:HAWESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42348
Practice Address - Country:US
Practice Address - Phone:270-927-1000
Practice Address - Fax:270-927-1077
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor