Provider Demographics
NPI:1750487526
Name:BROSSARD, PATRICIA A (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:BROSSARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3907 FARMINGTON LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60051-5175
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 S WYNSTONE PARK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:N BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6979
Practice Address - Country:US
Practice Address - Phone:847-540-6060
Practice Address - Fax:847-277-8012
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0024949396OtherBCBS PROVIDER #
ILT90519Medicare UPIN
IL0024949396OtherBCBS PROVIDER #