Provider Demographics
NPI:1710941885
Name:BROEG, RICHARD A (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:BROEG
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 1:8850 LOWER RIVER RD
Mailing Address - Street 2:
Mailing Address - City:RABBIT HASH
Mailing Address - State:KY
Mailing Address - Zip Code:41005-8696
Mailing Address - Country:US
Mailing Address - Phone:859-689-1317
Mailing Address - Fax:
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001261Medicaid
KYT54398Medicare UPIN
KY85001261Medicaid