Provider Demographics
NPI:1437303203
Name:BROCKWAY CHIROPRACTIC
Entity Type:Organization
Organization Name:BROCKWAY CHIROPRACTIC
Other - Org Name:TRANQUILITY CHIROPRACTIC & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BROCKWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-889-1659
Mailing Address - Street 1:425 S. CHERRY ST.
Mailing Address - Street 2:SUITE 307
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1230
Mailing Address - Country:US
Mailing Address - Phone:720-889-1659
Mailing Address - Fax:720-889-2873
Practice Address - Street 1:425 S. CHERRY ST.
Practice Address - Street 2:SUITE 307
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1230
Practice Address - Country:US
Practice Address - Phone:720-889-1659
Practice Address - Fax:720-889-2873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6392111N00000X
CO6283261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty