Provider Demographics
NPI:1043495849
Name:BRODHEAD CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:BRODHEAD CHIROPRACTIC CENTER, LLC
Other - Org Name:BRODHEAD CHIROPRACTIC CENTER, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-897-3080
Mailing Address - Street 1:807 16TH ST.
Mailing Address - Street 2:
Mailing Address - City:BRODHEAD
Mailing Address - State:WI
Mailing Address - Zip Code:53520
Mailing Address - Country:US
Mailing Address - Phone:608-897-3080
Mailing Address - Fax:608-897-4353
Practice Address - Street 1:807 16TH ST
Practice Address - Street 2:
Practice Address - City:BRODHEAD
Practice Address - State:WI
Practice Address - Zip Code:53520-1744
Practice Address - Country:US
Practice Address - Phone:608-897-3080
Practice Address - Fax:608-897-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty