Provider Demographics
NPI:1467510479
Name:BRODERICK FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:BRODERICK FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BRODERICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:856-228-4477
Mailing Address - Street 1:123 EGG HARBOR RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9406
Mailing Address - Country:US
Mailing Address - Phone:856-228-4477
Mailing Address - Fax:856-228-8365
Practice Address - Street 1:123 EGG HARBOR RD
Practice Address - Street 2:SUITE 307
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9406
Practice Address - Country:US
Practice Address - Phone:856-228-4477
Practice Address - Fax:856-228-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC005756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty