Provider Demographics
NPI:1205844925
Name:BRANDYWINE FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BRANDYWINE FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BROODY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-942-1940
Mailing Address - Street 1:1728 HORSE SHOE PIKE
Mailing Address - Street 2:
Mailing Address - City:GLENMOORE
Mailing Address - State:PA
Mailing Address - Zip Code:19343-1036
Mailing Address - Country:US
Mailing Address - Phone:610-942-1940
Mailing Address - Fax:610-942-1940
Practice Address - Street 1:1728 HORSE SHOE PIKE
Practice Address - Street 2:
Practice Address - City:GLENMOORE
Practice Address - State:PA
Practice Address - Zip Code:19343-1036
Practice Address - Country:US
Practice Address - Phone:610-942-1940
Practice Address - Fax:610-942-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005412L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2305606000OtherINDEPENDANCE BC/BS
PA2305606000OtherINDEPENDANCE BC/BS