Individual
DR. JERALD R BRODERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
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
Primary
306
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084724
BLUE CROSS/BLUE SHIELD
IN
05
—
100112520A
—
IN
01
—
306
COMMERCIAL/WC/AA
IN
Enumeration date
04/25/2006
Last updated
03/16/2010
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