Brockhouse, Victoria J

Brockhouse, Victoria J is an individual health care provider with primary practice located at 702 W Chestnut St , Bloomington IL 61701-2814. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Brockhouse, Victoria J can be contacted via phone (309) 567-1400.

Contact Information

Primary practice address
702 W Chestnut St Bloomington IL 61701-2814
Phone: (309) 567-1400
Fax: (309) 557-1461
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 336.043935 Illinois
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036081580 Illinois

Profile Details

NPI number 1790744555
LBN Legal business name Brockhouse, Victoria J
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 21st, 2006
Last updated Mar 15th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790744555 NPPES
Other 036081580 STATE LIC
Other 833120 STATE LIC
MEDICAID 036081580 STATE LIC
Other 080040113 STATE LIC
Other CA2264 STATE LIC
Other 336043935 STATE LIC

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