Organization
REGINA P. BROCKMAN, D.C., PLLC
Active
Other names
Brockman Chiropractic, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REGINA P. BROCKMAN D.C. (OWNER)
(859) 336-8446
Entity
Organization
Contact information
Practice address
3951 BARDSTOWN RD, SPRINGFIELD, KY 40069-8450
(859) 336-8446
Mailing address
PO BOX 327, SPRINGFIELD, KY 40069-0327
(859) 336-8446
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4174
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2448139000
PASSPORT ADVANTAGE PROVID
KY
01
—
2719881000
PASSPORT ADV. GROUP
KY
01
—
50006949
PASSPORT HLTH PROV#
KY
01
—
50010765
PASSPORT HLTH GRP#
KY
Enumeration date
05/09/2007
Last updated
10/24/2011
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