Provider Demographics
NPI:1518067503
Name:BROCKMAN, PETER JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
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 1:2745 CITRUS TOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6699
Mailing Address - Country:US
Mailing Address - Phone:352-241-4111
Mailing Address - Fax:352-241-4113
Practice Address - Street 1:2745 CITRUS TOWER BLVD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6699
Practice Address - Country:US
Practice Address - Phone:352-241-4111
Practice Address - Fax:352-241-4113
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV01955Medicare UPIN
FL54026ZMedicare PIN