Organization
BRODERICK CHIROPRACTIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN A BRODERICK (OFFICE MANAGER)
(574) 264-4151
Entity
Organization
Contact information
Practice address
1424 JOHNSON ST, ELKHART, IN 46514-3404
(574) 264-4151
(574) 262-9891
Mailing address
1424 JOHNSON ST, ELKHART, IN 46514-3404
(574) 264-4151
(574) 262-9891
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
08000306A
IN
111N00000X
Chiropractor
Primary
08000723A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084724
BLUE CROSS
IN
01
—
000000112128
BLUE CROSS
IN
05
—
100112520A
—
IN
05
—
100203690A
—
IN
Enumeration date
10/15/2014
Last updated
10/15/2014
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