Healthcare Provider Details

I. General information

NPI: 1437303203
Provider Name (Legal Business Name): BROCKWAY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S. CHERRY ST. SUITE 307
DENVER CO
80246-1230
US

IV. Provider business mailing address

425 S. CHERRY ST. SUITE 307
DENVER CO
80246-1230
US

V. Phone/Fax

Practice location:
  • Phone: 720-889-1659
  • Fax: 720-889-2873
Mailing address:
  • Phone: 720-889-1659
  • Fax: 720-889-2873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6392
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number6283
License Number StateCO

VIII. Authorized Official

Name: DR. JOHN DAVID BROCKWAY
Title or Position: EXECUTIVE, OWNER
Credential: D.C.
Phone: 720-889-1659