Provider Demographics
NPI:1437989167
Name:BROCHIN, GANNON (DC)
Entity type:Individual
Prefix:DR
First Name:GANNON
Middle Name:
Last Name:BROCHIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 CRAG BURN LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-6907
Mailing Address - Country:US
Mailing Address - Phone:423-430-0886
Mailing Address - Fax:
Practice Address - Street 1:1413 CRAG BURN LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-6907
Practice Address - Country:US
Practice Address - Phone:919-391-0314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor