Healthcare Provider Details

I. General information

NPI: 1861414138
Provider Name (Legal Business Name): MARJORIE A BROCKMAN R.N., D.C., C. AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 IDAHO ST
GOODING ID
83330-1258
US

IV. Provider business mailing address

445 IDAHO ST
GOODING ID
83330-1258
US

V. Phone/Fax

Practice location:
  • Phone: 208-934-5000
  • Fax: 208-934-5284
Mailing address:
  • Phone: 208-934-5000
  • Fax: 208-934-5284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-749
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACC66
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: