Provider Demographics
NPI:1184668824
Name:BROCKMAN, JEFFREY LLOYD (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LLOYD
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 1:441 E LYTLE ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3812
Mailing Address - Country:US
Mailing Address - Phone:615-430-7529
Mailing Address - Fax:
Practice Address - Street 1:4205 HILLSBORO PIKE
Practice Address - Street 2:SUITE 210
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3336
Practice Address - Country:US
Practice Address - Phone:615-463-2323
Practice Address - Fax:615-385-4065
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
3971184Medicare ID - Type Unspecified