Provider Demographics
NPI:1760726301
Name:BROTHERTON FAMILY AND SPORTS CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:BROTHERTON FAMILY AND SPORTS CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.C.
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-665-4099
Mailing Address - Street 1:406 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:IA
Mailing Address - Zip Code:51450-7710
Mailing Address - Country:US
Mailing Address - Phone:712-665-4099
Mailing Address - Fax:
Practice Address - Street 1:406 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE VIEW
Practice Address - State:IA
Practice Address - Zip Code:51450-7710
Practice Address - Country:US
Practice Address - Phone:712-665-4099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty