Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | A05402 | IA |
NPI | 1346334984 |
---|---|
Provider Name | Dr. James Lee Brockhohn |
First Address | Forest City, IA 50436 |
Second Address | Forest City, IA 50436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |