Provider Demographics
NPI:1609029966
Name:BROGHAMMER, NATHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:BROGHAMMER
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 1:214 BLAIRS FERRY RD NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-1602
Mailing Address - Country:US
Mailing Address - Phone:319-378-1515
Mailing Address - Fax:319-378-9292
Practice Address - Street 1:214 BLAIRS FERRY RD NE
Practice Address - Street 2:SUITE 2
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-1602
Practice Address - Country:US
Practice Address - Phone:319-378-1515
Practice Address - Fax:319-378-9292
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA88848OtherBLUE CROSS BLUE SHIELD
IA88848OtherBLUE CROSS BLUE SHIELD