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BRODERICK CHIROPRACTIC CENTER

>> Chiropractor >> Chiropractic Providers

Registrant NPI Number: 1184028490

Organizational Registrant:
Organization Name:  BRODERICK CHIROPRACTIC CENTER
Organization is not Subpart
Authorized Official:  SUSAN A BRODERICK  OFFICE MANAGER  574--26-44151

Location and contact information for practice:
1424 JOHNSON ST  ELKHART, IN 46514-3404 US
Tel: 574-264-4151  Fax: 574-262-9891

Contact information for business:
1424 JOHNSON ST  ELKHART, IN 46514-3404 US
Tel: 574-264-4151  Fax: 574-262-9891

Registration Information:
NPI: 1184028490
Entity Type: Organization

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N111N00000XChiropractic Providers
Chiropractor
IN08000306A
Y111N00000XChiropractic Providers
Chiropractor
IN08000723A

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
BLUE CROSS000000112128IN01
100112520AIN05
BLUE CROSS000000084724IN01
100203690AIN05




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