Organization
BRODA CHIROPRACTIC & SPORTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL MARK BRODA D.C. (OWNER)
(704) 987-9818
Entity
Organization
Contact information
Practice address
9605 CALDWELL COMMONS CIR, SUITE C, CORNELIUS, NC 28031-8138
(704) 987-9818
(704) 987-9718
Mailing address
9605 CALDWELL COMMONS CIR, SUITE C, CORNELIUS, NC 28031-8138
(704) 987-9818
(704) 987-9718
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3157
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085MJ
BCBS
NC
Enumeration date
12/12/2006
Last updated
09/04/2014
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