Provider Demographics
NPI:1508874215
Name:BROODY, ROBERT JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:BROODY
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 1:1728 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:610-942-1942
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:610-942-1942
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005412L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0698462000OtherINDEPENDANCE BLUE CROSS/S
PA2005606000OtherINDEPENDANCE BLUE C/S
PA1626467Medicare ID - Type Unspecified
PA2005606000OtherINDEPENDANCE BLUE C/S