Provider Demographics
NPI:1760668263
Name:BROERSMA, DENISE MISHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:MISHELLE
Last Name:BROERSMA
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 1:5230 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3105
Mailing Address - Country:US
Mailing Address - Phone:520-327-3099
Mailing Address - Fax:
Practice Address - Street 1:5230 E 8TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3105
Practice Address - Country:US
Practice Address - Phone:520-327-3099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU76965Medicare UPIN
29255Medicare PIN