Provider Demographics
NPI:1578909206
Name:BROADUS CHIROPRACTIC SERVICES, LLC
Entity Type:Organization
Organization Name:BROADUS CHIROPRACTIC SERVICES, LLC
Other - Org Name:SPINECARE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:BROADUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-400-5300
Mailing Address - Street 1:102 FONTAINBLEAU DR UNIT D1
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-6518
Mailing Address - Country:US
Mailing Address - Phone:985-400-5300
Mailing Address - Fax:985-400-5301
Practice Address - Street 1:102 FONTAINBLEAU DR # D1
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-6518
Practice Address - Country:US
Practice Address - Phone:985-400-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty