Provider Demographics
NPI:1760612634
Name:BROCKWAY, JOHN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:BROCKWAY
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 1:425 S CHERRY ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246
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:STE. 307
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1226
Practice Address - Country:US
Practice Address - Phone:720-889-1659
Practice Address - Fax:720-889-2873
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor