Provider Demographics
NPI:1124028717
Name:BROLSMA, LORI A (DC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:BROLSMA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 NEWARK POMPTON TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457
Mailing Address - Country:US
Mailing Address - Phone:973-831-1100
Mailing Address - Fax:973-831-6622
Practice Address - Street 1:7 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1142
Practice Address - Country:US
Practice Address - Phone:973-831-1100
Practice Address - Fax:973-831-6622
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00417000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U49753Medicare UPIN
ZU770982Medicare ID - Type Unspecified