Individual
JACK BROADDUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1200 S STATE ST, ANN ARBOR, MI 48109
(734) 647-2583
Mailing address
11309 PORTER PIKE, OAKLAND, KY 42159
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601002903
MI
Other
Enumeration date
06/26/2023
Last updated
06/26/2023
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