Provider Demographics
NPI:1710008560
Name:RICHARD A BROEG DC PSC
Entity Type:Organization
Organization Name:RICHARD A BROEG DC PSC
Other - Org Name:BROEG CHIROPRACTIC & NUTRITION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROEG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-525-2020
Mailing Address - Street 1:P.O. BOX 1057
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41022-1057
Mailing Address - Country:US
Mailing Address - Phone:859-525-2020
Mailing Address - Fax:859-525-0472
Practice Address - Street 1:1029 BURLINGTON PIKE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1235
Practice Address - Country:US
Practice Address - Phone:859-525-2020
Practice Address - Fax:859-525-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3438111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001261Medicaid
KY00441Medicare PIN
KYT54398Medicare UPIN