Provider Demographics
NPI:1548582430
Name:STEVEN BROMBERG DC
Entity Type:Organization
Organization Name:STEVEN BROMBERG DC
Other - Org Name:BROMBERG CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-494-1166
Mailing Address - Street 1:201 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1955
Mailing Address - Country:US
Mailing Address - Phone:617-494-1166
Mailing Address - Fax:
Practice Address - Street 1:201 BROADWAY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1955
Practice Address - Country:US
Practice Address - Phone:617-494-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty