Provider Demographics
NPI:1205858826
Name:BROUSSEAU, WILLIAM T (DC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:T
Last Name:BROUSSEAU
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 1:227 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-2614
Mailing Address - Country:US
Mailing Address - Phone:610-372-6646
Mailing Address - Fax:610-775-4496
Practice Address - Street 1:227 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-2614
Practice Address - Country:US
Practice Address - Phone:610-372-6646
Practice Address - Fax:610-775-4496
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC3826L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1205858826OtherNPI
PA1205858826OtherNPI
541697Medicare ID - Type Unspecified