Provider Demographics
NPI:1639247067
Name:BROOM, CARL EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:EDWARD
Last Name:BROOM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14873 GRANADA DR
Mailing Address - Street 2:UNIT 11
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-7902
Mailing Address - Country:US
Mailing Address - Phone:361-949-7687
Mailing Address - Fax:
Practice Address - Street 1:6170 IH 10 E
Practice Address - Street 2:BUILDING 2
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78219-4507
Practice Address - Country:US
Practice Address - Phone:210-661-4800
Practice Address - Fax:210-661-4808
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX9253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor