Individual provider Active NPI

Nicholas Adam Brockman, D.C.

  • Chiropractor
  • Hawesville, KY
National Provider Identifier
1114105319
Registry record updated Jul 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5101 Issued in KY
Practice address
135 Main Cross St
Hawesville, KY 42348
Phone
(270) 927-1000
Fax
(270) 927-1077
NPI assigned
Feb 11, 2008
Last updated
Jul 8, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 5101 KY Primary

Addresses

Primary practice location

135 Main Cross St
Hawesville, KY 42348

Mailing address

PO Box 242
Hawesville, KY 42348-0242
Phone (270) 927-1000

Other practice location 1

602 Main St
Tell City, IN 47586-1704
Phone (812) 772-2300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN, FL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20080326000309 KY Practitioner - Chiropractic 0143306555 Reassigns benefits to 1 organization
I20100315000551 IN Practitioner - Chiropractic 0143306555 Reassigns benefits to 1 organization
I20200925001980 FL Practitioner - Chiropractic 0143306555 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2441 Hwy 98
Suite 103
Santa Rosa Beach, FL 32459
Phone (850) 622-0062

35 Joshua LN
Hawesville, KY 42348-3500
Phone (270) 927-1000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Wellness Chiropractic, PLLC Chiropractor CurrentSince Feb 18, 2008 Accepting new patients

Locations

602 Main St
Tell City, IN 47586
Phone (812) 608-0468

35 Joshua Ln
Hawesville, KY 42348
Phone (270) 927-1000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594166400000",
    "number": "1114105319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 242",
            "city": "HAWESVILLE",
            "state": "KY",
            "postal_code": "423480242",
            "telephone_number": "270-927-1000",
            "fax_number": "270-927-1077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 MAIN CROSS ST",
            "city": "HAWESVILLE",
            "state": "KY",
            "postal_code": "42348",
            "telephone_number": "270-927-1000",
            "fax_number": "270-927-1077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "602 Main St",
            "address_purpose": "LOCATION",
            "city": "Tell City",
            "state": "IN",
            "postal_code": "475861704",
            "country_code": "US",
            "telephone_number": "812-772-2300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCKMAN",
        "first_name": "NICHOLAS",
        "middle_name": "ADAM",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-11",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "KY",
            "license": "5101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hawesville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.