Jerald R Broderick in Elkhart - Chiropractor
Jerald R Broderick - NPI 1518923945
Jerald R Broderick is a Chiropractor in Elkhart, Indiana. Jerald R Broderick practices all healthcare services and medical treatments related to Chiropractor. The NPI Number for Jerald R Broderick is 1518923945. The last update date is 2010-03-16.
Jerald R Broderick's current location address is 1424 Johnson St, Elkhart, Indiana. You can contact this provider via phone number 5742644151 and fax number 5742629891. The mailing address for Jerald R Broderick is 1424 Johnson St, Elkhart, Indiana. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jerald R Broderick |
|---|---|
| Address | 1424 Johnson St, Elkhart, Indiana |
| Phone Number | 5742644151 |
| Fax Number | 5742629891 |
| Sole Proprietor | Y |
| Credentials | D.C. |
NPI Number Detail
| NPI Number | 1518923945 |
|---|---|
| Provider Enumeration Date | 2006-04-25 |
| Last Updated Date | 2010-03-16 |
Provider Mailing Address Detail
| Address | 1424 Johnson St |
|---|---|
| City | Elkhart |
| State | Indiana (IN) |
| Post Code | 465143404 |
| Phone Number | 5742644151 |
| Fax Number | 5742629891 |
Provider's Primary Taxonomy Detail
| Speciality | Chiropractor |
|---|---|
| Taxonomy | 111N00000X |
| Licence No | 306 |
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Definition: A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its inte |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 100112520A | IN | -- | |
| 306 | IN | COMMERCIAL/WC/AA | |
| 84724 | IN | BLUE CROSS/BLUE SHIELD |
Post Comment/ Review Below
What is the unique provider identifier assigned to Jerald R Broderick?
The Jerald R Broderick has been issued the NPI (National Provider Identifier) 1518923945 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code is a unique identification number for healthcare providers.
Where is the Jerald R Broderick located?
The Jerald R Broderick is located at 1424 Johnson St, Elkhart, IN 465143404.
What is Jerald R Broderick's area of specialization, and what is the corresponding taxonomy classification code for this field of practice?
The specialized area of practice for Jerald R Broderick is Chiropractor, and the taxonomy code that categorizes this field of expertise is 111N00000X.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1518923945 to Jerald R Broderick?
The Centers for Medicare & Medicaid Services originally issued the 1518923945 to Jerald R Broderick on 2006-04-25.
When was the information related to Jerald R Broderick most recently updated or refreshed?
The details pertaining to the Jerald R Broderick, including its address, specialty, and other relevant information, were last updated or refreshed on 2010-03-16.