Individual
CHARLES A BROBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC, PA,
Contact information
Practice address
1600 W 22ND ST, SIOUX FALLS, SD 57105-1521
(605) 312-1000
(605) 312-1001
Mailing address
1600 W 22ND ST, SIOUX FALLS, SD 57105-1521
(605) 312-1000
(605) 312-6100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0922
SD
363AM0700X
Medical Physician Assistant
0922
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005375
BCBS
SD
05
—
7604240
—
SD
01
—
BR021953
BCBS
ND
Enumeration date
12/08/2006
Last updated
06/22/2020
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