Individual
MARJORIE A BROCKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N., D.C., C. AC
Contact information
Practice address
445 IDAHO ST, GOODING, ID 83330-1258
(208) 934-5000
(208) 934-5284
Mailing address
445 IDAHO ST, GOODING, ID 83330-1258
(208) 934-5000
(208) 934-5284
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
CHIA-749
ID
171100000X
Acupuncturist
Primary
ACC66
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010023081
BLUE SHIELD PROVIDER #
ID
01
—
C-7499
BLUE CROSS PROVIDER NUM
ID
Enumeration date
07/24/2006
Last updated
09/11/2025
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