Provider Demographics
NPI:1629177019
Name:BROSTOWIN, JAMES JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOHN
Last Name:BROSTOWIN
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 1:14 PINE EDGE PL
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8146
Mailing Address - Country:US
Mailing Address - Phone:631-243-2436
Mailing Address - Fax:
Practice Address - Street 1:3487 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2000
Practice Address - Country:US
Practice Address - Phone:516-221-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004582111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician