Healthcare Provider Details

I. General information

NPI: 1831709526
Provider Name (Legal Business Name): CALLIE ROSEANN BROCKETT DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CALLIE ROSEANN MILLSAP DC

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W 6TH ST
HUGOTON KS
67951-2206
US

IV. Provider business mailing address

517 NE 12TH ST
GUYMON OK
73942-4433
US

V. Phone/Fax

Practice location:
  • Phone: 620-544-4774
  • Fax:
Mailing address:
  • Phone: 580-338-2070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-06071
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: