Provider Demographics
NPI:1326102666
Name:BROUGHTON, BRUCE G (D C)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:G
Last Name:BROUGHTON
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18484 HIGHWAY 18
Mailing Address - Street 2:STE 280B
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307
Mailing Address - Country:US
Mailing Address - Phone:760-946-4619
Mailing Address - Fax:760-946-2360
Practice Address - Street 1:18484 US HIGHWAY 18
Practice Address - Street 2:STE 280B
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2375
Practice Address - Country:US
Practice Address - Phone:760-946-4619
Practice Address - Fax:760-946-2360
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor