Provider Demographics
NPI:1053448597
Name:BROST, DEAN P (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:P
Last Name:BROST
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1252
Mailing Address - Country:US
Mailing Address - Phone:715-748-4343
Mailing Address - Fax:715-748-1531
Practice Address - Street 1:1377 N 8TH ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1252
Practice Address - Country:US
Practice Address - Phone:715-748-4343
Practice Address - Fax:715-748-1531
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38885600Medicaid
WI38885600Medicaid