Provider Demographics
NPI:1144693888
Name:BROSTEK, SARA (DC)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:BROSTEK
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 1:8152 25 MILE RD
Mailing Address - Street 2:STE E
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1904
Mailing Address - Country:US
Mailing Address - Phone:586-992-6960
Mailing Address - Fax:586-992-6962
Practice Address - Street 1:8152 25 MILE RD
Practice Address - Street 2:STE E
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316-1904
Practice Address - Country:US
Practice Address - Phone:586-992-6960
Practice Address - Fax:586-992-6962
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor