Provider Demographics
NPI:1760430706
Name:BROUGHTON, ERIC MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MARTIN
Last Name:BROUGHTON
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 1:260 E HORSETOOTH RD
Mailing Address - Street 2:
Mailing Address - City:FT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3124
Mailing Address - Country:US
Mailing Address - Phone:970-223-2866
Mailing Address - Fax:970-223-2867
Practice Address - Street 1:260 E HORSETOOTH RD
Practice Address - Street 2:
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3124
Practice Address - Country:US
Practice Address - Phone:970-223-2866
Practice Address - Fax:970-223-2867
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO04529OtherSUB ID
COBR634129OtherBC/BS ID
COC48793OtherPROVIDER ID
COCO04529OtherSUB ID