Individual
DR. KENICE ANNE BROUGHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
4555 N LINCOLN AVE, CHICAGO, IL 60625-2102
(386) 763-2763
Mailing address
4555 N LINCOLN AVE, CHICAGO, IL 60625-2102
(773) 328-8153
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
038.005796
IL
111NN1001X
Nutrition Chiropractor
CH0006374
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000872000
—
FL
Enumeration date
08/02/2006
Last updated
01/13/2025
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